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A 45-year-old construction worker is brought to the Emergency Department because of mental confusion. His family thinks he has been ill for about 3 months during which time he has lost 22 pounds because of loss of appetite. His chief complaints are excessive fatigue and weakness. He has been irritable, confused, and disoriented for the last three days.
Laboratory Data
Sodium        115 mmol/L
Potassium        4.8 mmol/L
Chloride        86 mmol/L
Bicarbonate        19 mmol/L
Glucose        90 mg/dL
BUN            9 mg/dL
Creatinine        0.9 mg/dL
Total protein    6.3 g/dL
Osmolality        244 mOsm/kg
Urine Sodium    116 mmol/24 hr
Urine Potassium    66 mmol/24 hr
Urine Osmolality (24 hr.)    665 mOsm/kg
1.    Identify the abnormal results.
2.    List four functions of electrolytes in the body.
3.    What are the four major compounds (hormones, enzymes) involved in electrolyte and water regulation?
4.    Are the urine values consistent with the plasma electrolyte and osmolality values?
Following a three-day period of fluid restriction, the plasma osmolality rose to 265 mOsm/kg and plasma sodium 124 mmol/L. The urine osmolality was 360 mOsm/kg and 24 hour urine sodium was reduced to 7 mmol/L.
Further biochemical analysis revealed the following.
Renin – decreased
Aldosterone – decreased
Antidiuretic hormone – increased
5.    What is the most likely cause of the hyponatremia in this patient based on the above results? Defend your answer and also state why the other selections cannot be the causative agent.
a.    Primary aldosteronism
b.    Primary adrenal insufficiency
c.    Diabetes inspidus
d.    Syndrome of inappropriate ADH secretion
e.    Psychogenic polydipsia
f.    Pseudohyponatremia
6.    State the site of production of each of the following compounds:
a.    Renin
b.    Aldosterone
c.    ADH
7.    What is the normal ratio of urinary sodium to urinary potassium?

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