Hotobhaga
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38) A 62-year-old man presents with status epilepticus. He has a history of small cell lung cancer. He has no history of hypertension, diabetes, thyroid disease or congestive heart failur
E. Examination reveals a male in a postictal state, with a blood pressure of 130/90 mm Hg. A funduscopic examination reveals no papilledema, his neck is suppl
E. Lungs are clear, his heart examination is normal without jugular venous distention. There is no edema or clubbing. Laboratory studies show:
Serum
Sodium 112 mEq/L
Potassium 4.0 mEq/L
Urea nitrogen 10 mg/dL
Creatinine 0.8 mg/dL
Urine
Osmolality 612 mOsmol/kg
Urine sodium 85 mEq/L
A head CT is normal. A chest x-ray film reveals a right perihilar mass unchanged from a film one month ago. Which of the following is the most appropriate initial step in management?
A. Demeclocycline
B. Fluid restriction
C. Hydrocortisone
D. Hypertonic saline
E. Thyroxine
Explanation:
The correct answer is D. Hypertonic saline would be the most advisable treatment. The patient has hyponatremia and seizures, which would suggest an acute drop in sodium. There is no mention of a brain lesion to explain the seizures. The patient most likely has a syndrome of inappropriate diuretic hormone secretion (SIADH) due to his lung cancer. Furosemide may be given with the hypertonic saline to promote water loss.
Demeclocycline (choice A) is a tetracycline antibiotic that causes a nephrogenic diabetes insipidus. It can be used to treat SIADH on a chronic basis. It will not work immediately and is not advised to acutely raise sodium
Fluid restriction (choice B) would be a good long-term treatment for SIADH but would be too slow to treat a patient with seizures.
Hyponatremia may be caused by Addison diseas
E. Only in this case will steroids (choice C) be of any valu
E.
Hypothyroidism can cause hyponatremi
A. However, there is no evidence that this patient has hypothyroidism, and giving empiric thyroxine (choice E) has no role in treating hyponatremi
A.
is fliud restriction not the correct answer?
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| ssrpk
Forum Fanatic
Topics: 154
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no this time its correct...
remember it this way,
- mild - serum Na+ 120-130 - fluid restriction
moderate - serum Na+ 110-120 - loops with normal saline oir demeclocycline
severe - serum Na+ below 110 or symptomatic - hypertonic saline
so even this patient had a serum Na+ of 125, answer would have remained the same
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| usmlestud
Forum Junior
Topics: 6
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fluid restriction wud be ok for asymptomatic hyponatremia....but in this case hypertonic saline wud be rite.....slow increase in serum sodium at 0.5 to 1.0 Meq/l to avoid central pontine myelinosis
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| Hotobhaga
Forum Elite
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thanks ssRpk... I will remember it now
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USMLE preparation is all about discovery. Discovery of your own capabilities....Julia Perch MD (iprep)
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| hanwin
Forum Senior
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Posts: 157
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Yes, this is symptomatic hyponatraemia.
Ans: hypertonic saline
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| dr in trouble
Forum Guru
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Posts: 610
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yes hypertonic saline
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