A 67-year-old woman presented with confusion and difficulty ambulating. Her labs showed hyponatremia. The provider diagnosed her with SIADH due to her medications for depression and referred her to the ED for management of SIADH. SIADH occurs when antidiuretic hormone levels are inappropriately elevated, causing water retention and dilutional hyponatremia.

1. Discussion: Development of SIADH.
Discussion: Development of SIADH.Discussion: Development of SIADH.1. A 67-year-old
Caucasian woman was brought to the clinic by her son who stated that his mother had
become slightly confused over the past several days. She had been stumbling at home and
had fallen once but was able to ambulate with some difficulty. She had no other obvious
problems and had been eating and drinking. The son became concerned when she forgot
her son’s name, so he thought he better bring her to the clinic.PMH-Type II diabetes mellitus
(DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse
several months agoSocial/family hx – non contributary except for 30 pack/year history
tobacco use.Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5
mg po q am started 2 months agoLabs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl,
Creatinine 1.1 mg/dl, Na+120 mmol/L,K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.The
APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and
management of syndrome of inappropriate antidiuretic hormone (SIADH).Question:Define
SIADH and identify any patient characteristics that may have contributed to the
development of SIADH. QUESTION 21. A 43-year-old female presents to the clinic with a
chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to
keep any food, liquids or medications down. The symptoms began 3 days ago and have not
responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The
temperature has reached as high as 102?F.Allergies: none known to drugs or food or
environmentalMedications-20 mg prednisone po qd, omeprazole 10 po qamPMH-significant
for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other
significant illnesses or surgeries.Social-denies alcohol, illicit drugs, vaping, tobacco
usePhysical examThin, ill appearing woman who is sitting in exam room chair as she said
she was too weak to climb on the exam table. VS Temp 101.2?F, BP 98/64, pulse 110, Resp
16, PaO2 96% on room air.ROS negative other than GI symptoms.Based on the patient’s
clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism
due to the lack of prednisone the patient was taking for her RA secondary to
vomiting.Question:Explain why the patient exhibited these symptoms? Discussion:
Development of SIADH. ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE
PAPERSQUESTION 31. A 64-year-old Caucasian female presents to the clinic with vague
symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she
feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and
she fortunately was able to pass the small stones without requiring lithotripsy or other

2. interventions. She was told by the urologist to follow up with her primary care provider
after the kidney stones has resolved.The APRN examining the patient orders a Chem 7
which revealed a serum Ca++ of 13.1 mg/dl. The APN believes the patient has primary
hyperparathyroidism and refers the patient to an endocrinologist who does a complete
work up and concurs with the APRN’s diagnosis. Discussion: Development of
SIADH.Question:What is the role of parathyroid hormone in the development of primary
hyperparathyroidism? QUESTION 41. A 64-year-old Caucasian female presents to the clinic
with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and
says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal
without trauma and currently is wearing a walking boot. She also had a bout of kidney
stones a few weeks ago and she fortunately was able to pass the small stones without
requiring lithotripsy or other interventions. She was told by the urologist to follow up with
her primary care provider after the kidney stones has resolved.The APRN examining the
patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes
the patient has primary hyperparathyroidism and refers the patient to an endocrinologist
who does a complete work up and concurs with the APRN’s diagnosis.Question 1 of
2:Explain the processes involved in the formation of renal stones in patients with
hyperparathyroidism.QUESTION 51. A 64-year-old Caucasian female presents to the clinic
with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and
says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal
without trauma and currently is wearing a walking boot. She also had a bout of kidney
stones a few weeks ago and she fortunately was able to pass the small stones without
requiring lithotripsy or other interventions. She was told by the urologist to follow up with
her primary care provider after the kidney stones has resolved.The APRN examining the
patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes
the patient has primary hyperparathyroidism and refers the patient to an endocrinologist
who does a complete work up and concurs with the APRN’s diagnosis.Question 2 of
2:Explain how a patient with hyperparathyroidism is at risk for bone fractures.QUESTION
61. A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy
with forearm gland insertion presents to the general surgeon for her post-operative
checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon
suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with
delayed vascularization of the implanted gland. She orders a Chem 20 to determine what
electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl
(normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1
mg/dl).Question:What serious consequences of hypoparathyroidism occur and
why?QUESTION 71. A 17-year-old boy is brought to the pediatrician’s office by his parents
who are concerned about their son’s weight loss despite eating more, frequent urination,
unquenchable thirst, and fatigue that is interfering with his school/work activities. He had
been seemingly healthy until about 3 months ago when his parents started noticing these
symptoms but put these symptoms down to his busy schedule including a part time job. He
admits to sleeping more and tires very easily. He denies any other symptoms.PMH-
noncontributory. No surgeries or major medical problems. Usual colds and ear infections as

3. a childAllergies-none knowFamily history- maternal uncle with “some kind of sugar
diabetes problem” but parents unclear on the exact disease processSocial-denies alcohol,
tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast
food store after school and on weekends.Labs in office: random glucose 220 mg/dl.Based on
his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes
Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up
and management plan.Question 1 of 6:The patient exhibited classic signs of Type 1 diabetes.
Explain the pathophysiology of “polydipsia.”QUESTION 81. A 17-year-old boy is brought to
the pediatrician’s office by his parents who are concerned about their son’s weight loss
despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering
with his school/work activities. He had been seemingly healthy until about 3 months ago
when his parents started noticing these symptoms but put these symptoms down to his
busy schedule including a part time job. He admits to sleeping more and tires very easily. He
denies any other symptoms.PMH-noncontributory. No surgeries or major medical
problems. Usual colds and ear infections as a child Discussion: Development of
SIADH.Allergies-none knowFamily history- maternal uncle with “some kind of sugar
diabetes problem” but parents unclear on the exact disease processSocial-denies alcohol,
tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast
food store after school and on weekends.Labs in office: random glucose 220 mg/dl.Based on
his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes
Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up
and management plan.Question 2 of 6:The patient exhibited classic signs of Type 1 diabetes.
Explain the pathophysiology of “polyuria.”QUESTION 91. A 17-year-old boy is brought to
the pediatrician’s office by his parents who are concerned about their son’s weight loss
despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering
with his school/work activities. He had been seemingly healthy until about 3 months ago
when his parents started noticing these symptoms but put these symptoms down to his
busy schedule including a part time job. He admits to sleeping more and tires very easily. He
denies any other symptoms.PMH-noncontributory. No surgeries or major medical
problems. Usual colds and ear infections as a childAllergies-none knowFamily history-
maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact
disease processSocial-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior
at local high school and works in a fast food store after school and on weekends.Labs in
office: random glucose 220 mg/dl.Based on his symptoms and the glucose level, the
pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and
his parents to an endocrinologist for further work up and management plan.Question 3 of
6:The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of
“polyphagia.”QUESTION 101. A 17-year-old boy is brought to the pediatrician’s office by his
parents who are concerned about their son’s weight loss despite eating more, frequent
urination, unquenchable thirst, and fatigue that is interfering with his school/work
activities. He had been seemingly healthy until about 3 months ago when his parents started
noticing these symptoms but put these symptoms down to his busy schedule including a
part time job. He admits to sleeping more and tires very easily. He denies any other

4. symptoms.PMH-noncontributory. No surgeries or major medical problems. Usual colds and
ear infections as a childAllergies-none knowFamily history- maternal uncle with “some kind
of sugar diabetes problem” but parents unclear on the exact disease processSocial-denies
alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works
in a fast food store after school and on weekends.Labs in office: random glucose 220
mg/dl.Based on his symptoms and the glucose level, the pediatrician makes a tentative
diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an
endocrinologist for further work up and management plan.Question 4 of 6: Discussion:
Development of SIADH.The patient exhibited classic signs of Type 1 diabetes. Explain the
pathophysiology of “weight loss.”