Name: SHAH, Adarsh

Candidate number:

Theme: Sodium Handling

OPTION LIST

A	Addisonian Crisis	G	Nephrogenic Diabetes Insipidus
B	Central Pontine Myelinosis	H	Pseudohyponatraemia
C	Conn’s Syndrome	I	Psychogenic Polydypsia
D	Cranial Diabetes Insipidus	J	SIADH
E	Cushing’s Syndrome	K	17α-hydroxylase deficiency
F	Diuretics	L	21-hydroxylase deficiency

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 33yr old Afro-Caribbean lady presents to A&E with her brother, who mentions that she has been diagnosed with a ‘lung disorder’ 6 months ago, and that she is on a high-dose steroid treatment since. O/E she is confused, tachycardic, hypotensive and Cushingoid. Routine blood tests reveal Na 120 mmol/L, K 6.2 mmol/L and Cl 103 mmol/L.

2. A 45yr old known alcoholic presents to A & E after collapsing and suffering a seizure. His GCS is 7/15 when you see him, and blood tests show a Na 117 mmol/L, K 2.9 mmol/L. Initial management involved admission and aggressive IV fluid replacement, but 2 days post-admission, the patient becomes confused, and develops a horizontal gaze and spastic quadriplegia.

3. A 24yr old male presents with polyuria. He normally drinks 2-3L of water. O/E he appears dehydrated. Na 129 mmol/L, K 3.2 mmol/L, random glucose 7 mmol/L and plasma osmolality 330 mOsm/kg. Urinalysis showed an osmolality of 175 mOsm/kg. Following a water deprivation test, urine osmolality was 160 mOsm/kg. He was treated with desmopressin.

4. A 17yr old female presents to the clinic complaining of primary amenorrhoea. O/E you note that she lacks secondary sexual characteristics and she is hypertensive. Na 150 mmol/L, K 2.7 mmol/L.

5. The routine blood tests of a 60yr old man, with no known co-morbitdities shows the following: Na 130 mmol/L, K 4.0 mmol/L, random glucose 7.2 mmol/L, Raised triglycerides and LDL cholesterol.

ANSWERS

1. A

2. B

3. D

4. K

5. H