2. An 85 year-old male presents to the emergency room with pneumonia. He has bee
ID: 128790 • Letter: 2
Question
2. An 85 year-old male presents to the emergency room with pneumonia. He has been febrile for several days and has had a cough productive of yellow sputum On physical exam he is a well-developed, thin male in moderate respiratory distress. Blood pressure (supine) 120/86 (normal- 107/66), pulse 74 (normal = 60-70), blood pressure (standing) 115/85 (normal-99/66), pulse 70 (normal = 70-90), respirations 24 and labored. Temperature was 39°C. Bodyweight 60 kg. HEENT exam was unremarkable. Cardiopulmonary exam demonstrated decreased breath sounds at the base of the right lung. The remainder of the exam was within normal limits Laboratory Data Chemistry Sodium Potassium Chloride Total CO2 BUN Creatinine Glucose Urine Sodium 60 mmol/L Potassium 30 mmol/L Osmolality 500 mosm/kg 120 3.9 87 24 10 0.8 90 Normal Values 136-146 mmol/L 3.5-5.3 mmol/L 98-108 mmol/L 23-27 mmol/L 7-22 mg/dl 0.7-1.5 mg/dl 70-110 mg/dl Explain what hormone is not being regulated in this patient. Based on what we covered in class, how does over secretion or under secretion of this hormone explain some of the symptoms seen in this patient.Explanation / Answer
Hyponatremia and ADH secretion:
Based on the given symptoms the patient was suffering with Hyponatremia. Antidiuretic hormone or arginine vasopressine is responsible for this Hyponatremia disease in the patient.
On average, a DI patient makes over 3 L of urine daily, when compared to a normal person's output of about 1.5 L. The urine is also very dilute, with an osmolality of less than 200 mOsm/kg in DI, compared to a normal value of about 500-800 mOsm/kg. In an effort to keep body fluid down, the kidneys excrete sodium ions into the urine. This makes hyponatremia
In this syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive release of antidiuritic hormone from the posterior pituitary gland or another source. The increase in blood volume often results in dilution hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased.
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