Check out that urine sodium. The guys pissing normal saline. That’s the highest urine sodium I have ever seen.
Urine sodium 148
Urine potassium 48
Serum sodium 124
Urine output 2350
Electrolyte free water clearance:
-1364 mL
Interpretation: with those urine electrolytes, when urinates 2,300 mL it is as if he actually drank nearly a liter and a half of tap water. And that is why fluid restriction fails in dense SIADH.
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Very interesting case. It might be a dumb question but still I am gonna ask
1. How to really differentiate at initial evaluation if high ur Na could be just coz patient was given large amounts of 0.9 NS or a component of SIADH.
2. When calculating electrolyte free water clearence the VOLUME & electrolytes of urine are in 24hrs or just random urine collection.
thanks for sharing this interesting case
Why was he receiving so much sodium? Was he receiving a bunch of normal saline or was he on a high-sodium diet?
though it looks like a ton of sodium, think about the ICU. They sling around tons of sodium: 0.9% NS at 100/hr is 3509 mmol of sodium, one amp of bicarb is 50 mmol of sodium. throw in a couple of boluses for whatever reason and its easy to see sick patients in the ICU receiving 400+ mmol of sodium.
In regards to separating out saline infusions from SIADH, this guy was dropping his sodium by one or two points a day and had been for a week.