Pre-Activity Questions

Evelyn is a 62-year-old woman who presented to the hospital emergency department with generalized weakness, nausea, headache, and anorexia. Examination was unremarkable; no edema was observed. Blood glucose and renal and liver function tests were within normal limits. Chest CT revealed a soft-tissue density mass involving the left para-aortic, para-tracheal, and right hilar regions. Laboratory results were as follows: K+ 3.5 mEq/L, Ca++ 8.1 mg/dL, uric acid 3.4 mg/dL, serum Na+ 127 mEq/L, urine osmolality 353 mOsm/kg H20, urine Na+ 138.8 mmol/L, and plasma osmolality 246.8 mOsm/kg. TSH and cortisol levels were within normal limits. 


For the next 2 days, Evelyn's laboratory data are as follows:


Day 1

Day 2

Serum sodium



24-hr urine output

755 mL

910 mL

Urine osmolality

633 mOsm/kg H20

601 mOsm/kg H20

Please use the scale: 1=NOT at all confident, 2=Not very confident, 3=Somewhat confident, 4=Confident, 5=Very confident
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