Syndrome of inappropriate antidiuretic hormone secretion Quiz: Ace Your Exams
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A 68-year-old woman is admitted to the hospital for evaluation of lethargy, confusion, and nausea for 3 days. She has no fevers, vomiting, diarrhea, or polyuria. Past medical history is significant for small cell lung cancer diagnosed 8 months ago, for which she receives chemotherapy. Her medications include pembrolizumab. Her temperature is 36.4°C (97.5°F), heart rate is 72/min, blood pressure is 120/80 mm Hg, respiratory rate is 16/min, and oxygen saturation is 96% on room air. On examination, the patient is oriented to person but not to place or time. Mucous membranes are moist. Cardiopulmonary examination is non-contributory. Neurologic examination is notable for slow response to commands. Laboratory tests reveal a serum sodium level of 115 mEq/L, urine osmolality of 350 mOsm/kg, and urine sodium of 50 mEq/L. Which of the following is the best next step in management?
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