A 72-year-old man with Alzheimer’s disease is brought to the emergency room by his daughter due to confusion and lethargy over the past few days. His daughter says that he has poor oral and he has been drinking very little water recently. On examination, patient is confused but has no focal neurological deficit and his mucous membranes are dry. His blood pressure is 100/65 mmHg, heart rate is 100 bpm. His medications include hydrochlorothiazide for hypertension. Laboratory tests show serum sodium 160 mEq/L (Normal: 135–145 mEq/L), serum osmolality: 315 mOsm/kg (high), urine osmolality: 600 mOsm/kg (high), and urine sodium: 10 mEq/L (low).
What is the most appropriate initial management?
More from Year 4
See allA a 68-year-old man with a history of gastroesophageal reflux disease presents with worsening kidney function over the past two weeks. He started a proton pump…
A 54-year-old man with no family history of prostate cancer attends his GP for a routine check-up. He is asymptomatic and has no significant past medical histor…
A 58-year-old man with no symptoms attends your clinic for a general health check. He is concerned because his uncle and cousin both died of pancreatic cancer.…
A 60-year-old man with a history of chronic diarrhea presents with muscle weakness and lethargy. Laboratory tests show: potassium 3.1 mmol/L (3.5-5.0 mmol/L), b…
A 50-year-old man presents to the emergency department with confusion, rapid breathing, and general weakness. He has a history of chronic kidney disease. On exa…