30-year-old woman comes to the physician complaining of a significant increase in her daily urinary volume and intense thirst

Medicoman · March 19, 2020, 10:50am

30-year-old woman comes to the physician complaining of a significant increase in her daily urinary volume and

intense thirst. The symptoms started a few weeks ago, and she has to get up frequently at night to urinate and

drink fluids. She has no other medical problems. The patient does not use tobacco, alcohol, or illicit drugs and

has no known drug allergies. Her mother developed diabetes mellitus as an adolescent. Temperature is 36.7 C

(98 F), blood pressure is 110/70 mm Hg, pulse is 75/min, and respirations are 15/min. F asting serum laboratory

results are as follows

Sodium 146 mEq/L

Potassium 4.0 mEq/L

Bicarbonate 24 mEq/L

Blood urea nitrogen 15 mg/dl

Creatinine 0.9 mg/dl

Glucose 90 mg/dl

Serum osmolality 300 mOsm/kg

Urine osmolality 126 mOsm/kg

After 6 hours of water deprivation, laboratory results are as follows:

Sodium 153 mEq/L

Serum osmolality 320 mOsm/kg

Urine osmolality 132 mOsm/kg

One hour after the subcutaneous administration of arginine vasopressin, the urine osmolality is 395 mOsm/kg.

Which of the following is the most appropriate treatment for this patient?

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