Diabetes insipidus and SIADH Quiz: Ace Your Exams

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A 37 year-old man is brought to the emergency department after a one-minute generalized tonic clonic seizure. The patient is confused, has difficulty answering questions, and is unable to provide additional history. Past medical records indicate that he has generalized anxiety and major depression managed with fluoxetine. Family history is notable for Addison disease in his mother. Temperature is 37.0°C (98.6°F), pulse is 70/min, respirations are 15/min and blood pressure is 115/75 mmHg. Cardiac, pulmonary, and abdominal examinations are noncontributory. Extremities examination shows multiple healing forearm lacerations. Laboratory results are as follows:
 
 Laboratory value  Result 
 Sodium   116 mEq/L 
 Potassium   3.5 mEq/L 
 Creatinine  0.9 mg/dL 
 Calcium  9.1 mg/dL 
 Glucose  102 mg/dL 
 Serum Osmolarity   245 mOsm/kg 
 Urine Osmolality  406 mOsm/kg 

A urine toxicology is ordered, and results are negative. Which of the following mechanisms best explains the patient's seizure?

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