bluestar
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30. A previously healthy 52-year-old man comes to the emergency department because of hiccups for 1 week. He has smoked two packs of cigarettes daily for 30 years. He does not drink alcohol. He is alert and oriented. His temperature is 37 C (98.6 F), blood pressure is 150/95 mm Hg, pulse is 70/min, and respirations are 12/min. Physical and neurologic examinations show no abnormalities. His serum sodium level is 120 mEq/L. An x-ray film of the chest shows a right hilar mass. Which of the following is the most appropriate next step in treatment? A ) Bisphosphonate therapy B ) Calcitonin therapy C ) Calcium therapy D ) Dexamethasone therapy E ) 5% Dextrose in 0.225% saline therapy F ) 5% Dextrose in 0.45% saline therapy G ) 5% Dextrose in water therapy H ) Fluid restriction I ) Hydrocortisone therapy J ) Lactated Ringer's solution K ) Mannitol therapy L ) Potassium therapy M ) 0.9% Saline therapy N ) 3% Saline therapy O ) Sodium bicarbonate therapy
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| nisha
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Predominantly we're lookin at hyponatremia due to SIADH...but since this paitent is asymptomatic, I would go with H) fluid restriction, this should bring back the sodium value to normal. Sever hyponatremia, with CNS symptoms would require agressive management with 3%saline and furosemide.
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| chemamr
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H, because of the serum level of Na
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| bobby
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h, should be correct as nisha explain it.
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| mani
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H ) Fluid restriction
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| bluestar
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according to Kaplan note,
serum sodium 120-130 and asymptomatic: fluid restriction
serum sodium 110-120 and asymptomatic: furosemide and NS
serum sodium <110 and symptomatic: hypertonic saline.
So I was kinda looking for a loop diuretics in the answers. Also, is there a position of mannitol in the treatment of SIADH? Since it helps excrete free water, theoretically it's perfect. but in reality, do we use it? also I wonder can we use thiazide in this situation? please answer.
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| mani
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i ve never heard of osmotic diuretics in SIADH
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| bluestar
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but still... I checked the internet and found it's used sometimes. but for the purpose of USMLE, maybe we'll just forget about it
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| Dot
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Yes mannitol is the drug of choice in Type 1 hyponatremia along with fluid restriction.Use of mannitol helps in solute diuresis.Type 1 is hypervolumic hyponatremia for ur knoledge
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| bluestar
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so still mannitol is not the choice for SIADH, right?
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