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Retired NBME 24 Answers

nbme24/Block 1/Question#14 (reveal difficulty score)
A thin 66-year-old man is brought to the ...
Urine osmolality > plasma osmolality ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +18  upvote downvote
submitted by โˆ—andro(269)
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SIADH is characterized by :

*Excessive free water retention ( less water in urine means specific gravity increases and not decreases as in option E)

*Euvolemic hyponatremia with continued urinary Na+ excretion ( and so urine Na which actually be greater than and not less than 10 mEq/L option D)

*Urine osmolality > serum osmolality ( option C)

Serum potassium does not actually decrease ( counter-intuitively ) because the excess fluid retention suppresses aldosterone secretion . The two main stimuli for potassium loss/secretion in kidneys are - aldosterone - and high urine flow rates. Both of these are decreased in SIADH ( excluding option B )

Serum urea nitrogen and creatinine are diluted , so their concentration decreases

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peridot  Great explanation, thank you so much!! +1



 +6  upvote downvote
submitted by โˆ—m-ice(370)
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In SIADH, the excessive ADH causes the collecting duct of the kidney to reabsorb huge amounts of water that it should normally excrete. That means that the plasma will now have much more water relative to solute (low osmolality) and the urine will have much more salt relative to water (higher osmolality).

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frijoles  So potassium does not become diluted in SIADH? +1
ruready4this  I feel like I was overthinking this question so much for some reason!! C definitely makes the most sense but I was also wondering what would happen to potassium. Then I was thinking maybe the excess ADH would suppress aldosterone secretion and serum potassium concentration would actually be higher +1
peridot  @frijoles Aldosterone can adjust the K+ levels: too much water --> less aldosterone --> no excretion of K+, so this helps retain the K+ to a normal level. However, less aldosterone also means --> more excretion of Na+, so the hyponatremia is not corrected. +1



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