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A 30-year-old female patient visited the outpatient clinic with a 6-week history of anorexia, fatigue, polydipsia, and excessive polyuria. The fluid intake had risen to 1.5 L/h, and a 24-hour urine collection yielded 18 L. Her blood pressure at home was 106/64 mm Hg with a pulse of 72/min, and she complained of muscle cramps. Physical examination showed an euvolemic patient in an otherwise normal condition. Laboratory investigation revealed a plasma osmolality of 298 mOsm/kg (298 mmol/kg) and a urine osmolality of 44 mOsm/kg (44 mmol/kg). Further laboratory tests were as follows: plasma sodium, 142.4 mEq/L (142.4 mmol/L); plasma potassium, 3.43 mEq/L (3.43 mmol/L); plasma chloride, 107.8 mEq/L (107.8 mmol/L); plasma bicarbonate, 27.8 mEq/L (27.8 mmol/L); urine sodium, <5 mEq/L (<5 mmol/L); and urine potassium, 3 mEq/L (3 mmol/L).

She was 2-months pregnant and, therefore, stopped taking her medication but continued a low-salt diet.

What is your diagnosis? What medication was stopped?

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Case provided by Annemie Vandermarliere, MD, Bart Maes, MD, PhD, and Yves Vanrenterghem, MD, PhD, Department of Nephrology, University Hospital Gasthuisberg, Leuven, Belgium.

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