Question 1: Syndrome of Antidiuretic Hormone (SIADH)
Normally, the secretion of antidiuretic hormone (ADH) is influenced by plasma osmolality. However, SIADH results when the ADH secretion is excessive regardless of the plasma osmolality, thus leading to increased water retention by kidneys and the resultant electrolyte imbalances worse, which is dilutional hyponatremia (Mentrasti et al., 2020). The patient presentation relates to such hyponatremia.
Different factors predispose an individual to SIADH development, including advanced age, drug use, brain disorders, and malignancies. The patient in the case study had some of these factors that might have predisposed her to develop the condition. She is older than 50 years, has type 2 diabetes mellitus, has a long-standing history of cigarette smoking, and is on different medications for managing depression, including antidepressants.
Patients with advanced age may develop ineffective secretion of ADH due to medications such as antidepressants and NSAIDs that interfere with renal function (Al-Hinai et al., 2021). Further, a history of smoking is suggestive of undiagnosed lung malignancy and emphysema that has been associated with SIADH. In addition, the patient had a history of falls from which she may have sustained intracranial bleeding, thus resulting in SIADH (Mentrasti et al., 2020). These factors should be investigated and appropriately addressed.
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