Question at position 22 Which condition is characterized by a normal sodium concentration but diluted by an increase in total body water?HypervolemiaHypotonic hydrationHypovolemiaEuvolemic hyponatremiaHypernatremia

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Question restated: Which condition is characterized by a normal sodium concentration but diluted by an increase in total body water?
Answer options: 1) Hypervolemia 2) Hypotonic hydration 3) Hypovolemia 4) Euvolemic hyponatremia 5) Hypernatremia

Option 1: Hypervolemia. This describes an overall increase in body fluid volume, which can lead to dilutional effects, but it does not specify that the sodium concentration remains normal while total body water increases. In many hypervolemic states, hyponatremia can occur, but the key feature given here is the maintenance of normal sodium concentration with dilution by water, which is not the defining hallmark of simple hypervolemia by itself. Misconception correction: hypervolemia often accompanies hyponatremia rather than guaranteeing a normal Na+ level.

Option 2: Hypotonic hydration. This term literally refers to a state of excess water relative to solute (hypotonic fluid overload), which dilutes all solutes including sodium and typically produces hyponatremia rather than a normal Na+ concentration. If there is dilution by total body water, you would expect a decreased sodium concentration, not a normal one. Misconception: dilutional states usually lower Na+.

Option 3: Hypovolemia. Hypovolemia means a decreased circulating blood volume. In this condition, one would expect relative hypernatremia or at least not a dilutional effect from increased total body water; the prompt emphasizes dilution by increased total body water, which is not characteristic of hypovolemia. Misconception: volume depletion tends to concentrate sodium rather than diluting it.

Option 4: Euvolemic hyponatremia. This state is classically described as normal total body sodium with an excess of total body water, leading to hyponatremia within a euvolemic (normal volume) clinical picture. While the typical teaching highlights low sodium concentration, the stem here emphasizes a normal Na+ concentration with dilution by water, which aligns with a situation where total body water expands relative to sodium while volume status remains normal; this matches the idea of dilution by increased water without overt volume overload. Supporting reasoning: the term “euvolemic” specifies normal extracellular volume, and hyponatremia arises from water excess rather than sodium loss, i.e., dilutional effect.

Option 5: Hypernatremia. Hypernatremia denotes an elevated sodium concentration, not a dilution by increased total body water. It contradicts the premise of a normal Na+ with dilution by water; thus it is inconsistent with the described condition. Misconception: the scenario describes dilution, not elevated sodium.

Summary: Among the choices, option 4 (Euvolemic hyponatremia) best fits the description of a condition characterized by normal sodium concentration that is diluted by an increase in total body water, given the clinical framing of normal volume status with water-related dilution. The other options fail to align with the combination of a normal Na+ level and dilution due to increased total body water, by describing either incorrect volume states or incorrect direction of the sodium change.

Question at position 22 Which condition is characterized by a normal sodium concentration but diluted by an increase in total body water?HypervolemiaHypotonic hydrationHypovolemiaEuvolemic hyponatremiaHypernatremia

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