WBR1068

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Electrolytes
Prompt	[[Prompt::A 67 year-old male comes to your office for follow up. The patient has a past medical history of alcoholic liver cirrhosis. On examination, his blood pressure is 110/90 mmHg, pulse 90 beat per minute, respiration 19/m, and temperature 37 C. Cardiopulmonary exam was unremarkable. Abdominal exam shows tense ascites and a shrunken liver. Lower extremities had 3+ pitting edema. His laboratory tests are shows serum sodium 127 (N: 135-146 mmol/L), urine sodium level > 20 mEq/L. Which of the following is the best next step in managing his hyponatremia?]]
Answer A	AnswerA::Hypotonic saline infusion
Answer A Explanation	[[AnswerAExp::Incorrect Hypotonic saline infusion is not indicated in the management of hyponatremia.]]
Answer B	AnswerB::Isotonic saline infusion
Answer B Explanation	[[AnswerBExp::Incorrect Isotonic saline infusion is only used with symptomatic cases of hyponatremia, when the sodium level reaches 125 mmol/L.]]
Answer C	AnswerC::Hypertonic saline infusion
Answer C Explanation	[[AnswerCExp::Incorrect Hypertonic saline infusion is only used with sever symptomatic cases of hyponatremia to prevent cerebral edema.]]
Answer D	AnswerD::Water restriction
Answer D Explanation	[[AnswerDExp::Correct In asymptomatic euvolemic hyponatremia, fluid restriction (less than 1 to 1.5 L per day) is the mainstay of the treatment.]]
Answer E	AnswerE::Intravenous diuretics
Answer E Explanation	[[AnswerEExp::Incorrect Intravenous diuretics is not indicated in the management of hyponatremia.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::The decrease in effective circulating arterial volume due to this patient`s liver disease is responsible for ADH secretion in this patient. Hyponatremia is defined as plasma sodium concentration less than 135 mEq/L. Most patients with hyponatremia are asymptomatic. Symptoms do not usually appear until the plasma sodium level drops below 120 mEq per L. Hyponatremia can be developed in cases of excess water intake that exceed the excretory capacity of the kidneys. Other causes include impaired renal functions and ability to excrete excess water, or inappropriate secretion of ADH. In asymptomatic euvolemic hyponatremia, fluid restriction (less than 1 to 1.5 L per day) is the mainstay of the treatment. Educational Objective: In asymptomatic euvolemic hyponatremia, fluid restriction (less than 1 to 1.5 L per day) is the mainstay of the treatment. References: http://www.wikidoc.org/index.php/Hyponatremia]]
Approved	Approved::No
Keyword	[[WBRKeyword::Hyponatremia]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::