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Old 09-14-2011
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Lungs Lung caner, appropriate next step?

A 70 YO male with history of lung cancer is brought to the ER, with increased confusion and lethargy over the past few days. He denies any recent head trauma or any other medical problems. He reports taking chemotherapy. On physical examination, his vital signs are stable, no jugular venous distension, and cardiac and lung exams are unremarkable. A CT scan does not show any brain metastases.

Laboratory results show:
Sodium: 121 mEq/L
Potassium: 4.4 mEq/L
Chloride: 100 mEq/:L
Bicarbonate: 21 mEq/L
What is the appropriate next step in the management of this apteint?
1. Diuretics & water orally.
2. IV isotonic saline.
3. Restricts water intake.
4. Renal function test.
5. Diuretic only.
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Old 09-14-2011
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Quote:
Originally Posted by ag2011n View Post
A 70 YO male with history of lung cancer is brought to the ER, with increased confusion and lethargy over the past few days. He denies any recent head trauma or any other medical problems. He reports taking chemotherapy. On physical examination, his vital signs are stable, no jugular venous distension, and cardiac and lung exams are unremarkable. A CT scan does not show any brain metastases.

Laboratory results show:
Sodium: 121 mEq/L
Potassium: 4.4 mEq/L
Chloride: 100 mEq/:L
Bicarbonate: 21 mEq/L
What is the appropriate next step in the management of this apteint?
1. Diuretics & water orally.
2. IV isotonic saline.
3. Restricts water intake.
4. Renal function test.
5. Diuretic only.
Would go with 3. SIADH!
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Old 09-14-2011
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nex step will be, 3. Restricts water intake. however if the question will be asked the best step then.... iv hypertonic solution (3%)
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Old 09-15-2011
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You guys are correct. The answer is SIADH.
SIADH usually seen in small cell carcinoma (10% of SCLC).
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