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15. Select the most appropriate diagnosis from the given list for the following U&Es
A 72-year-old male presents with weakness and weight loss.
Aldosterone antagonists
Angiotensin converting enzyme inhibitors
Digoxin
Insulin
Thiazide diuretics
ANSWERS
1. 135mEq/L
2. Hyponatraemia
3. Decreased intake
4. Decrease
5. SIADH
6. Hypernatraemia
7. Hyponatraemia
8. SIADH (Mnemonic: 6Ss - Sleep disturbance, sexual dysfunction, Seretonin
syndrome, Sickness (nauseau), Slow onset (of eectiveness)
9. Hyponatraemia
10. Hypernatraemia
11. Central pontine myelinosis, locked in syndrome
12. Hypernatraemia
13. Small lung cancer: Mnemonic: Small cell = Small Sodium
14. Decreased
15.
This is a dilutional hyponatraemia with all parameters low but a profound hyponatraemia.
This suggests SIADH which may be due to conditions such as pneumonia, subarachnoid
haemorrhage (or head injury) and malignancies such as bronchial carcinoma - this may
liberate ectopic ADH.
The weight loss and fatigue associated with hyponatraemia are important here and with
the hyperkalaemia and high urea suggest a diagnosis of Addison's disease - primary
hypoadrenalism. The condition is typically autoimmune in origin and is associated with
hypotension so the patient may also describe dizziness. It is diagnosed with a short
synacthen test with low responses of cortisol to the ACTH stimulus. Steroid therapy can
be life saving.
This man with type 2 diabetes mellitus has impaired renal function and this would suggest
chronic renal failure most probably related to diabetic nephropathy. Other common
causes of chronic renal impairment include hypertension , intrinsic renal disease and
drugs such as non-steroidal therapy.
16.
Aldosterone antagonists (for example, spironolactone) are used as potassium sparing
diuretics and may cause hyperkalaemia.
Digoxin does not cause hypokalaemia but care should be taken to avoid hypokalaemia if
it is used with a diuretic, as hypokalaemia predisposes to digoxin toxicity.