Case #2
A 60 year-old male with alcoholic cirrhosis presents to your office because of worsening edema.
On physical exam the patient is a well-developed, poorly nourished, jaundiced male in mild distress due to his anasarca. Blood pressure (supine) 110/75, pulse 100, (standing) 90/60, pulse 120, respirations 23 and he was afebrile. Body weight 80 kg. Cardiopulmonary exam was unremarkable. The abdomen was remarkable for tense ascites and a shrunken liver. Lower extremities had 3+ pitting edema.
Laboratory Data
| Chemistry | Normal Values | Urine | |
| Sodium | 127 | 136-146 mmol/L | Sodium 6 mmol/L Osmolality 600 mosm/kg |
| Potassium | 3.6 | 3.5-5.3 mmol/L | |
| Chloride | 96 | 98-108 mmol/L | |
| Total CO2 | 23 | 23-27 mmol/L | |
| BUN | 35 | 7-22 mg/dl | |
| Creatinine | 1.8 | 0.7-1.5 mg/dl | |
| Glucose | 105 | 70-110 mg/dl |
1. Calculate the serum osmolality in this patient?
Answer
2. What is the cause of hyponatremia in this patient? Answer
3. Based on what criteria was this diagnosis made?
Answer
4. What is the total body sodium in this patient? Answer
5. What are the physiologic conditions which stimulate ADH secretion?
Answer
6. What is the clinical condition responsible for ADH secretion in this
patient ? Answer
7. If furosemide is administered to this patient how will it change the
urinary composition? Answer
8. What are the major categories of hyponatremia and their pathogenesis?
Answer
Integrative Questions
9. What accounts for the differences in total body sodium in these two cases? Answer 10. Why are there differences in the urinary sodium between the two cases?
Answer