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mcq

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jamdoc
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11/10/06 - 02:01 PM

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ssrpk
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11/10/06 - 04:45 PM

glucocorticoids and thryoid hormones are responsible for adequate suppression of ADH following waterload...thts a normal phenomena!

considering the abv statement, it maybe hyperthyroidism tht is counteracting the effects of ADH, but i'll check!

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fox
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11/10/06 - 05:06 PM

NO..it looks like he is having nephrogenic DI....but none of the answers seems to fit in confused

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me007
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11/10/06 - 05:12 PM

it's might be diabetes type 2

jamdoc
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11/10/06 - 08:34 PM

me007 wrote:
it's might be diabetes type 2

ur right.

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smal
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11/10/06 - 11:26 PM

ya of the option,i think DM2.
since pt is dehydrated.
diuresis not corrected by ADH(cause is osmotic)
inc. Na+ is due to aldosterone trying to maintain osmolality.......by retaining water and salt,but water is lost by osmotic diuresis.

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ManuNastai
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11/11/06 - 12:20 AM

wtf?

well, in DM2, the patient loses electrolites too.. that doesn't explain the hypernatremia!

hypoaldosteronism is out of the question.. and fat, vit D, don't know about hyperthiroidism..

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Leopard
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11/11/06 - 02:56 PM

smal wrote:
ya of the option,i think DM2.
since pt is dehydrated.
diuresis not corrected by ADH(cause is osmotic)
inc. Na+ is due to aldosterone trying to maintain osmolality.......by retaining water and salt,but water is lost by osmotic diuresis.

I agree with this opinion

Best of luck

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ssrpk
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11/12/06 - 04:35 AM

i agree with smal's eplanation [good one]

Na+ level and K+ level does reduce with DKA because they are excreted along with organic anions which are not covered by H+/NH4+ secretion in the renal tubules!

therefore in hyperosmolar states associated with DM2, as there aren't many organic anions in the plasma, total body Na+ and K+ losses are minimal! infact Na+ level may appear to reduced by usual lab tests, and it needs to corrected for the degree of osmolality! [Harrison's]

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jamdoc
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11/12/06 - 09:45 AM

#10

type 2 DM usually are resistant to DKA

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