Hyponatremia in a patient with diabetic ketosis: Questions

A 16-year-old male patient was admitted to our hospital with the complaints of drinking too much water and polyuria lasting for 3 weeks and prominent weight loss. For the last week, weakness, dizziness, and nausea accompanied his complaints. There was no known disease in our patient or in his family members. He was the first child of parents with first-degree consanguinity. In the physical examination, hypotension (70/40 mm/Hg), dryness of the mucous membranes, severe dehydration, and hyperpigmentation of the skin were the most remarkable features. Hyperglycemia, hyponatremia, and hyperkalemia were conspicuous in initial blood tests of the patient. Urine density was 1018; he had glycosuria of 4+ and trace ketone bodies. Microscopic examination of urine was normal. Our patient did not have any gastrointestinal loss, nephritis, diuretic use history, or signs of infection. Clinical findings and laboratory evaluation results were consistent with diabetic ketosis. Antibodies were requested for type 1 diabetes mellitus. The laboratory values of the patient are in Table 1. …