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  #1  
Old 04-15-2011
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Question Physiologic Status in this patient

A 25-year-old woman has a 3-day history of vomiting and diarrhea. She has postural hypotension and poor tissue turgor. Her serum sodium concentration is 130 mEq/L. Which of the following findings is most likely?
(A) Decreased serum aldosterone concentration
(B) Increased serum atrial natriuretic peptide concentration
(C) Increased effective circulating volume
(D) Increased serum ADH (vasopressin) concentration
(E) Urine osmolality less than serum osmolality
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  #2  
Old 04-15-2011
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The answer would be increase in ADH (vasopressin) secretion.
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Old 04-15-2011
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D) Increased ADH (because of decreased blood volume)
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Old 04-15-2011
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Yeah inceased ADH !

Just remembered a Goljan pearl point ....fluid disorder Serum Na <120 always Suspect SIADH .................
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Old 04-15-2011
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(A) Decreased serum aldosterone
concentration
(B) Increased serum atrial natriuretic
peptide concentration
(C) Increased effective circulating volume
(D) Increased serum ADH (vasopressin)
concentration
(E) Urine osmolality less than serum
osmolality[/QUOTE]

i think answer is D- increased ADH. the patient is obviously volume-depleted so
A is wrong because aldosterone increases in such condition.
B is wrong because ANP is stimulated by volume OVERLOAD.
C is wrong because dehydration decreases effective circulating volume.
E is wrong because extensive water reabsorption will make urine osmolality MORE than serum osmolality
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Old 05-25-2011
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The answer is D: Increased serum ADH (vasopressin) concentration.

The patient has SIADH and in such patients free water is reabsorbed thereby developing hyponatremia as seen in the question with the sodium concentration of 130mEq/L, which is decreased.
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Old 05-25-2011
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Quote:
Originally Posted by MedStateOfMind View Post
The answer is D: Increased serum ADH (vasopressin) concentration.

The patient has SIADH and in such patients free water is reabsorbed thereby developing hyponatremia as seen in the question with the sodium concentration of 130mEq/L, which is decreased.
I donīt think the patient has SIADH though. Volume depletion causes an appropriate (nonosmotic) secretion of ADH.
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Old 05-25-2011
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Quote:
Originally Posted by Rawalian View Post
A 25-year-old woman has a 3-day history of vomiting and diarrhea. She has postural hypotension and poor tissue turgor. Her serum sodium concentration is 130 mEq/L. Which of the following findings is most likely?
(A) Decreased serum aldosterone concentration
(B) Increased serum atrial natriuretic peptide concentration
(C) Increased effective circulating volume
(D) Increased serum ADH (vasopressin) concentration
(E) Urine osmolality less than serum osmolality
D) Increased serum ADH
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Endocrine-, Physiology-, Renal-, Step-1-Questions

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