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USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam |
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#1
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A 26-year-old woman is brought to the
emergency department by her mother 1 hour after she had a generalized tonic-clonic seizure at home. The mother states that her daughter has been talking to herself at all hours of the day and night about being thirsty. The patient was found to have schizophrenia 6 years ago. Her only medication is haloperidol. She was admitted to the hospital twice in the past year for psychotic episodes. Physical examination shows no other abnormalities. She is oriented to person but not to place or time. Her serum sodium concentration is 114 mEq/L on arrival but returns to normal with appropriate treatment. Which of the following interventions is the most appropriate next step? (A) Refer the patient for behavior therapy (B) Restrict the patient's fluid intake (C) Add lithium carbonate to the medication regimen (D) Administer furosemide therapy (E) Begin mineralocorticoid therapy answer is b. but I dont understand why we restrict fluid intake. Could someone explain it to me? Thank you ![]() |
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Khorreed (07-11-2015) |
#2
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![]() Quote:
![]() ![]() ![]() Her serum sodium concentration is 114 mEq/L(normal 135-140 mEq/L) Sodium concentration decrease tell us about excessive amount of fluid(because Sodium CONCENTRATION depends ONLY on amount of fluid and not on the total body sodium concentration) More water - concentration of sodium would be less(hyponatremia) Less water in blood - concentration of sodium would be more(hypernatremia) More TOTAL body sodium(concentration*extracellular volume) - edema Less TOTAL body sodium(concentration*extracellular volume(variable from patient to patient) - dont remember now(maybe collapse?). So, if there is lowering of sodium concentration - there is excess water That is why we need to restrict water intake |
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med_doc (07-11-2015) |
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![]() Quote:
episodes…She is oriented to person but not to place or time.” Also half-life of haloperidol is 21-24h. SO water restriction is the only option The following is the pubmed’s link to the related article http://www.ncbi.nlm.nih.gov/pubmed/487691 Haloperidol-induced syndrome of inappropriate secretion of antidiuretic hormone(SIADH). Can’t really take off the Haloperidol because “She was admitted to the hospital twice in the past year for psychotic episodes…She is oriented to person but not to place or time.” Also half-life of haloperidol is 21-24h. SO h2o restriction is the only option The following is the pubmed’s link to the related article to make sure that you would never forget about that.. ![]() http://www.ncbi.nlm.nih.gov/pubmed/487691 Last edited by med_doc; 07-11-2015 at 01:46 AM. |
The above post was thanked by: | ||
Khorreed (07-11-2015) |
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