USMLE Step 1 Quiz
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RENAL SYSTEM
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A 65-year-old man with a 40-pack-year smoking history and recently diagnosed small cell lung cancer presents to the emergency department with increasing confusion and lethargy over the past 3 days. He has no history of head trauma or neurologic disease. His temperature is 37.1°C (98.8°F), blood pressure is 130/80 mm Hg, pulse is 88/min, and respirations are 16/min. Physical examination reveals a lethargic man who is oriented only to person. He has no focal neurologic deficits. Laboratory studies show a serum sodium of 118 mEq/L, serum osmolality of 245 mOsm/kg, and urine osmolality of 450 mOsm/kg.
Which of the following is the most likely mechanism underlying this patient's hyponatremia?
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