Presentation of Case
A 55-year-old woman with a history of alcoholism was brought to the emergency department in a confused state by her daughter, who reported that the patient had been weak and had fallen several times in the past week. The daughter said that about 2 weeks previously her mother had been given a prescription for hydrochlorothiazide to treat elevated blood pressure.
On examination, the patient was disoriented and noncooperative but arousable. Her blood pressure was 140/82 mm Hg, the pulse was 88 beats per minute, and she was afebrile. The cranial nerves were intact. The optic disks were normal, as were extraocular movements. An ear, nose, and throat examination was normal except for mucosa that appeared to be slightly dry. The lungs were clear. The heart sounds were normal, and there was no murmur. Abdominal examination revealed no organomegaly or masses. The skin was cool and clammy. A neurologic examination revealed tremors and increased deep-tendon reflexes.
Laboratory data showed a plasma sodium concentration of 112 mmol per liter, and the potassium level was 2.6 mmol per liter. The urine osmolality was 630 mOsm per kilogram of water, and the urinary sodium level was 12 mmol per liter.
Question
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