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* Neuro Form 4
 #852741  
  kennychan - 07/04/18 16:55
 
  A 52-year old woman is brought to the emergency department by her husband 30 minutes after a generalized tonic-clonic seizure. Her husband reports that she has had a headache and has seemed confused over the past 3 days. She was scheduled to be evaluated by a pulmonologist later this week for the recent onset of mild hemoptysis. She smoked two packs of cigarettes daily for 30 years but quite 5 years ago. She has a 5-year history of type 2 diabetes mellitus controlled by diet. On arrival she is postictal. Her temperature is 37C, and blood pressure is 110/60 mm Hg. She is minimally responsive to painful stimuli. Cardiopulmonary examination shows no abnormalities. There is no peripheral edema. There are no focal neurologic deficits. Laboratory studies show:
Serum
Na+ 112 mEq/L
Glucose 150 mg/dL

Creatinine 0.7 mg/dL
Cholesterol 230 mg/dL
Osmolality 238 mOsmol/Kg

Urine
Glucose trace
Protein none
RBC 1-3/hpf
WBC 1-3/hpf
Osmolality 240 mOsmol/Kg
Na+ 25 mEq/L

Which of the following is the most likely diagnosis
a) Bacterial pneumonia
b) Cirrhosis of the liver
c) Decreased solute intake
d) Dehydration
e) Glucocorticoid deficiency (wrong)
f) Hyperglycemia
g) Intracranial neoplasm
h) Meningitis
i) Nephrotic syndrome
j) Pseudohyponatremia
k) Psychogenic polydipsia
l) Renal failure

Please give me your opinions and explanations. Thanks.
 
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* Re:Neuro Form 4
#3369028
  kennychan - 07/09/18 17:30
 
  Please help!  
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* Re:Neuro Form 4
#3369046
  captan - 07/09/18 21:02
 
  k) Psychogenic polydipsia
low Na + low serum osmolality + low urine osmolality
 
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* Re:Neuro Form 4
#3369053
  kennychan - 07/09/18 23:21
 
  Totally, agree with you. Thanks,  
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* Re:Neuro Form 4
#3369197
  kapprep2011 - 07/12/18 11:10
 
  no the answer is G
in K the urine osm will be low
 
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* Re:Neuro Form 4
#3369198
  kapprep2011 - 07/12/18 11:11
 
  its inapp ADH
 
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* Re:Neuro Form 4
#3369199
  captan - 07/12/18 11:42
 
  NO !!!!!!!!!!Not SIADH
Diagnostic tools for SIADH

1) HypoNA
2)serum osmla < 275
3) urine osm > 300
4) Urine Na > 40


i that case pt have low urine osm
 
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* Re:Neuro Form 4
#3369248
  kapprep2011 - 07/13/18 01:10
 
  the pt has a history of smoking and mild hemoptysis which makes lung cancer in your differential.
 
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