A 62-year-old man with a history of congestive heart failure (CHF) presents with confusion, nausea, and vomiting. Physical examination reveals peripheral edema, bibasilar crackles, and jugular venous distention. The patient is found to have a sodium level of 112 mEq/L. The physician places the patient on free water restriction. Which of the following laboratory values do you expect with respect to the fractional excretion of sodium (FENa) and urine sodium (UNa) with this condition? FENa UNa(A) >1% <10 mEq/L(B) >1% >20 mEq/L(C) <1% <10 mEq/L(D) <1% >20 mEq/L
Question
A 62-year-old man with a history of congestive heart failure (CHF) presents with confusion, nausea, and vomiting. Physical examination reveals peripheral edema, bibasilar crackles, and jugular venous distention. The patient is found to have a sodium level of 112 mEq/L. The physician places the patient on free water restriction. Which of the following laboratory values do you expect with respect to the fractional excretion of sodium (FENa) and urine sodium (UNa) with this condition? FENa UNa(A) >1% <10 mEq/L(B) >1% >20 mEq/L(C) <1% <10 mEq/L(D) <1% >20 mEq/L
Solution
The patient's symptoms and history suggest that he is suffering from congestive heart failure (CHF) with hyponatremia, which is a low sodium level in the blood. This condition is often associated with a syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is a common cause of hyponatremia in patients with CHF.
In SIADH, the body retains water, leading to dilutional hyponatremia. The kidneys respond to this by decreasing the fractional excretion of sodium (FENa), which is the percentage of the filtered load of sodium that is excreted in the urine. This is because the body is trying to conserve sodium in response to the perceived low volume state. Therefore, the FENa would be less than 1%.
At the same time, the urine sodium (UNa) concentration would be high because the kidneys are trying to excrete the excess water while conserving sodium. Therefore, the UNa would be greater than 20 mEq/L.
So, the correct answer would be (D) <1% FENa and >20 mEq/L UNa.
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