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Case: Part A) A 34-year-old female who lives alone. Her partner found her after failing to respond to texts or phone calls for two days. Finally, she was found on the bathroom floor, severely dehydrated and barely conscious. Her partner brought her to the emergency department and told the staff he thought she had been drunk previously. The ED provider notices dry mucous membranes and orders several laboratory tests.
Assay
Test Result
Reference Interval
Serum osmolality:
278 mOsm/kg
275-295 mOsm/kg
Glucose:
75 mg/dL
70 - 100 mg/dL
BUN:
10 mg/dL
6-20 mg/dL
Na+:
129 mmol/L
135-145 mmol/L
Urine Na+:
8 mmol/L (random)
>20 mmol/L
Reference Range
K+:
3.0 mmol/L
3.5-5.1 mmol/L
Cl-:
77 mmol/L
98-107 mmol/L
HCO3-
9 mmol/L
22 - 28 mmol/L
Mg+:
0.45 mmol/L
0.66-1.07 mmol/L
Ionized Ca2+:
1.0 mmol/L
1.15-1.33 mmol/L
Question 1: Explain how the sodium, potassium, chloride, and urine sodium results relate to her condition.
Question 2: Explain why her ionized calcium is low and how it's affected by magnesium.
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