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NBME 20 Answers

nbme20/Block 2/Question#34 (25.8 difficulty score)
A 28-year-old man has excessive thirst and ...

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submitted by hayayah(1101),
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tP hsa btaseide sn.diiusp

If ruien totcnnreeacs tiwh snadtirinmoati fo DAH ,loanga hte kyiedns era seorsenivp adn eht molbper is itwh AHD cptoiondru ni hte ashlptmhyuoa ro rsaeeel ni eth ops.t ttpuari.yi

hello_planet  FA 2019 pg. 344 +3  
djeffs1  first aid (and my school) say if U-Osm doesnt increase by 50% or more, then its still nephrogenic. Not so according to NBME... +  

submitted by sugaplum(411),
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heTes lwyaas dirtpep me up:
+ olPdaipysi= rsospdne ot arwte ai,onpredivt olw esurm aN
+ eratl=Cn rpssoedn to svs,eprisnoa hgih esrum aN
go hir+necNpe = nrsdosep ot otng,nhi nmoarl mreus aN

lynn  I think serum Na+ only depends on the patient's access to water. FA19 pg 344 says serum osm is high in both and doesn't mention Na specifically. Spent a while double checking for DI, but low serum Na for polydipsia is definitely correct. +  
drzed  In general, SIADH or polydipsia will cause HYPOnatremia, and DI (central or nephrogenic) will cause HYPERnatremia, but in the latter--as you stated--water access change the serum Na. +