Board question of the week: Water-1

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A 40-year-old woman is rushed to ER for change in mental status. She has a history of multiple sclerosis and alcohol abuse. On arrival to ER, she exhibits 3 stereotyped, tonic-clonic seizure that resolve with ativan. The initial metabolic panel is listed below:
Na- 115, K- 1.6, Cl- 56, HCO3- 40, BUN- 10, Cr- 0.8, Serum osmolality- 240 Her husband arrives at the ER and reports heavy alcohol use over the last few weeks. He brings her medication list, which includes: Protonix, Tysabri (natalizumab, anti-alpha-4-integrin antibody), and Prednisone. Blood work from 3 months prior show a normal sodium level. She received 2L of normal saline in the ER, 80 meq of KCl, and one dose of lasix. Her urine output has been 3L so far. Urine electrolytes are obtained (Una 75, Uk 10). She weighs 100kg and on examination the patient is noted to be in “status”. Nephrology is consulted for the management of her hyponatremia.

How should this patient be managed acutely?Possible answers are listed in the poll on the upper right hand column.

The answer and explanation will be posted on Friday August 27th

Michael Lattanzio DO

*RFN board questions are meant to help introduce concepts about nephrology related diseases and do not represent actual questions seen on the ABIM exam.

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