38 year old athelete with hyponatremia, Chest tightness, SOB and cough.

freecme000
Published on Apr 29, 2022
CC – chest tightness, SOB, productive cough.

HPI –38-year-old athlete developed SOB, chest tightness 2 days after completion of a marathon race, drank 4.5 L fluid (water & electrolyte drinks) during a marathon race with no bathroom breaks.

MEDS -None

EXAM – HR 85, BP 165/85, RR 22, Afebrile, O2 Sat 85% RA, B/L diffuse coarse crepitations, normal heart sounds. No Edema, No JVD, Alert and Awake.

EKG – ST depression ( 0.5 mm)- leads V4-6 .

LABS

Na 117 mmol/L, K 4.5, Cr 1.8 mg/dl

Plasma osmolality 249 mmol/kg

Urine osmolality 389 mmol/kg

Spot urine potassium 20 mmom/L

Spot urine sodium 101 mmom/L

B-natriuretic peptide (BNP) 2950 pg/Ml

troponin I peak of 0.34 ug/L, Sputum culture negative

2D ECHO showed mild hypokinesis of the inferior wall of the LV with trivial MR, Heart size, wall thickness and global LV/RV systolic function were normal.

NEXT STEP IN MANAGEMENT OF HYPONATREMIA
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A) IV LASIX PLUS 3 PERCENT HYPERTONIC SALINE

B) IV LASIX PLUS ORAL TOLVAPTAN

C) IV LASIX PLUS STRICT FLUID RESTRICTION

D) IV LASIX ONLY

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https://renal.medcase.com/free_cme/hyponatremia-chest-tightness-sob-productive-cough/