78 year old male with metastatic myeloma presenting with AMS , polyuria and neutropenic fever.

freecme000
Published on Feb 11, 2022
CC - AMS - polyuria, neutropenic fever (101.5) degrees
HPI 75-year-old gentleman with PMH DM TYPE 2, recent diagnosis of multiple myeloma was started on chemotherapy with CyBorD regimen. - He was started on empiric IV antibiotic therapy with cefepime for neutropenic fever. He was subsequently started on non-liposomal preparation of amphotericin

EXAM - VS stable, AMS barely arousable. Urine output in 24 hours 5 L/day

LABS - NA 155, chloride 124, potassium 3.5, magnesium 1.6 BUN 125, creation 4.4, bicarbonate of 16, calcium 11.2
PTH 45 pg/mL, 24-hour urine potassium was 45 mEq/day, 24-hour urine magnesium was 85 mg/day, Urine osmolality 150 mOsm/L

IMAGING - MRI brain shows revealed a 3.1 X 2.6 X 3.6 cm lobulated metastatic mass lesion in left lateral ventricle trigone

Following a desmopressin challenge as per standard protocols, a dose of 10 μg of desmopressin was administered intranasally thrice daily. Subsequently, the patient’s blood serum sodium levels gradually fell from 155 mEq/L to 153 mEq/L. His urinary output decreased to 4.5 L/day and then 4.3 L/day, respectively after the administration of desmopressin.

Which is the most likely reason for patients' polyuria?
A. Amphotericin B
B. osmolar diuresis from high BUN
C. Metastatic brain lesion
D. Hypercalcemia

Answer - Please Click Link Below
https://renal.medcase.com/free_cme/78-year-old-male-with-metastatic-myeloma-with-ams-polyuria-neutropenic-fever/