A 68-year-old man is admitted to the hospital for worsening shortness of breath during the past 2 weeks attributable to heart failure. His serum Na concentration on admission was 123 mEq/L. Other abnormal laboratory values include brain natriuretic peptide 850 and Cr 1.7 mg/dL. Chest radiograph is consistent with pulmonary edema. The patient weighs 85 kg on admission, which is up 3 kg from his baseline weight. The patient is not experiencing nausea, headache, or mental status changes. The physician orders 3% NaCl to treat the hyponatremia. Which one of the following recommendations is best?

A 72-year-old woman with a history of hypertension has developed hyponatremia after starting hydrochlorothiazide 3 weeks earlier. She experiences dizziness, fatigue, and nausea. Her serum Na+ is 116 mEq/L.Her weight is 60 kg, BP is 86/50 mm Hg, and HR is 122 beats/minute.
1. Which one of the following initial treatment regimens is most recommended?

- A 72-year-old, 60-kg woman is hospitalized with confusion and visual hallucinations that started 1 day ago. Her serum sodium was 118 mEq/L on admission. Her vital signs are stable. She started taking hydrochlorothiazide 25 mg/day 3 weeks before hospital admission.1. Which of the following is the most appropriate treatment goal for the first 24 hours for this patient?

2. Which of the following is the best concentration of NaCl to administer?

06- An 88-year-old man was hospitalized for pneumonia and sepsis 2 days ago. He received appropriate antibiotics and intravenous fluids of 0.9% NaCl at 100 mL/hour. Currently, his WBC has decreased, he is afebrile, his vital signs are stable, and his urine output is 45 mL/hour. Other than a K+ of 3.4 mEq/L, his laboratory values are normal. He is tolerating an oral diet. 1. Which of the following is most appropriate?

An elderly man is hospitalized for worsening shortness of breath during the past 2 weeks. He has a history of heart failure. Pertinent laboratory values and vital signs include Na+ 123 mEq/L, creatinine 1.7 mg/dL, and B-type natriuretic peptide 850 pg/mL. His chest radiograph shows pulmonary congestion, and he has BP 132/84 mm Hg, HR 105 beats/minute, and weight 85 kg (up 3 kg from baseline). The patient is not experiencing nausea, headache, or mental status changes. An order is written for 23.4% NaCl 30 mL intravenously for one dose.

1.Which of the following is the most appropriate recommendation?

CAS is a 25 YO female with diabetes who comes into the clinic with a blood glucose of 360 mg/dl. Her other lab values are as follows: Na= 140 meq/l, Cr = 1.0, BUN = 23 mg/dl and k = 3.7 meq/l. Calculate her serum Osmolality.

DR is a 40-year-old man admitted for confusion and altered mental status. His physical exam is unremarkable. His vital signs are stable with a heart rate of 80 BPM, respiratory rate of 14 BPM, and blood pressure of 120/70 mm Hg. DR’s past medical history is includes only a long standing history of depression, currently treated with paroxitine controlled release 50 mg PO daily. DR weighs 82 kg. His admission labs show a Na 119 mEq/L (normal 136–146), K 3.6 mEq/L (normal 3.5–5.2), Cl 100 mEq/L (normal 100–110), CO2 32 mEq/L (normal 21–33), BUN 7 mg/dl (normal 7–23), glucose
80 mg/dl (normal 70–110), albumin 2.4 g/dl (normal 3.2–4.8), Ca 9.2 mEq/L (normal 8.8–10.5), magnesium 2.0 mEq/L (normal 1.6–2.2), Phos 4.1 mmol/L (normal 2.4–4.3). DR’s doctor orders additional labs to evaluate the hyponatremia. The results are as follows. A spot urine sodium is 22 mEq/L and urine osmolality is 180 mOsm/L. Which one of the following is the best initial treatment for DR’s hyponatremia?

- A 71-year-old woman visited her physician who adjusted several of her medications. Three days later she presents with a headache, nausea and confusion. She has type 2 diabetes, dyslipidemia, hypertension and depression. She is taking metoprolol 25 mg twice daily, chlorthalidone 25 mg daily, chlorpropamide 500 mg daily, simvastatin 40 mg daily, and sertraline 50 mg daily. Laboratory tests were performed and the patient was diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH).Which one of the following clinical findings is most important in the diagnosis of SIADH?

A 72-year-old woman, newly admitted to the medical intensive care unit from a nursing home, presents with no significant medical history. Several days ago at the nursing home, she was treated for a urinary tract infection with levofloxacin. Today, she is disoriented and somnolent, with a temperature of 102ºF, and is transferred to the hospital. She is intubated in the field for worsening hypoxemia (Pa02, 55 mm Hg), and blood pressure on arrival is 72/50 mm Hg. Her heart rate is 106 beats/minute, and urine output is 15 mL/hour.

Which is the best therapy for this patient?