A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?
Sodium level of 150 mEq/L (range 135-145 mEq/L)
Phosphate level of 4.0 mg/dL (range 2.5-4.5 mg/dL)
Blood glucose level of 60 mg/dL (range 60-100 mg/dL)
Potassium level of 2.9 mmol/L (range 3.5-5 mEq/L)
The Correct Answer is A
Reasoning:
Choice A reason: A sodium level of 150 mEq/L indicates hypernatremia, which occurs in diabetes insipidus when fluid restriction exacerbates water loss from polyuria. Without adequate ADH, the kidneys cannot conserve water, and restricting fluids further increases serum sodium concentration, reflecting dehydration and supporting the suspicion of fluid restriction.
Choice B reason: A phosphate level of 4.0 mg/dL is within the normal range and unrelated to fluid restriction in diabetes insipidus. Phosphate levels are affected by bone metabolism or renal function, not directly by ADH deficiency or fluid intake, making this finding irrelevant to the client’s fluid management strategy.
Choice C reason: A blood glucose level of 60 mg/dL is at the lower end of normal but unrelated to fluid restriction in diabetes insipidus. Glucose levels are affected by metabolic conditions like diabetes mellitus, not water balance issues caused by ADH deficiency, so this does not indicate fluid restriction.
Choice D reason: A potassium level of 2.9 mmol/L indicates hypokalemia, which is not directly linked to fluid restriction in diabetes insipidus. Potassium imbalances may result from other causes, like diuretic use or gastrointestinal losses, but they do not reflect the dehydration or sodium concentration changes associated with restricted fluid intake.
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Correct Answer is D
Explanation
Reasoning:
Choice A reason: A sodium level of 140 mEq/L is within the normal range and not diagnostic of Addison’s disease. This condition, caused by adrenal insufficiency, typically leads to hyponatremia due to reduced aldosterone, which decreases sodium reabsorption, making a normal sodium level uncharacteristic of the disease.
Choice B reason: A glucose level of 100 mg/dL is normal and not specific to Addison’s disease. Hypoglycemia is more common due to cortisol deficiency, which impairs gluconeogenesis. A normal glucose level does not support the diagnosis, as it does not reflect the metabolic disruptions of adrenal insufficiency.
Choice C reason: A blood pressure of 135/90 mm Hg is elevated but not diagnostic of Addison’s disease. The condition typically causes hypotension due to reduced aldosterone and cortisol, leading to low blood volume and vascular tone. Hypertension suggests another etiology, not adrenal insufficiency.
Choice D reason: A potassium level of 6.0 mEq/L indicates hyperkalemia, a diagnostic sign of Addison’s disease. Aldosterone deficiency reduces potassium excretion in the kidneys, leading to elevated serum potassium. This, combined with hyponatremia and hypotension, is a hallmark of adrenal insufficiency, making hyperkalemia a key diagnostic finding.
Correct Answer is C
Explanation
Reasoning:
Choice A reason: Above-normal urine osmolality and below-normal serum osmolality are not consistent with diabetes insipidus. High urine osmolality suggests concentrated urine, typical in syndrome of inappropriate antidiuretic hormone (SIADH), where ADH is excessive. Low serum osmolality also aligns with SIADH due to water retention, not the water loss seen in diabetes insipidus.
Choice B reason: Above-normal urine and serum osmolality levels do not reflect diabetes insipidus. High urine osmolality indicates concentrated urine, which contradicts the dilute urine output of diabetes insipidus. High serum osmolality could occur with dehydration, but the combination with high urine osmolality suggests another condition, not ADH deficiency.
Choice C reason: Below-normal urine osmolality and above-normal serum osmolality are classic findings in diabetes insipidus. Arginine vasopressin (ADH) deficiency impairs water reabsorption, leading to dilute urine (low osmolality). The resulting water loss increases serum osmolality as the body becomes dehydrated, supporting the diagnosis of diabetes insipidus.
Choice D reason: Below-normal urine and serum osmolality levels are inconsistent with diabetes insipidus. Low urine osmolality occurs due to ADH deficiency, but low serum osmolality suggests water retention, as in SIADH. Diabetes insipidus causes dehydration, elevating serum osmolality, not lowering it, making this combination unlikely in this condition.
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