A 55 year-old male smoker presents with cough. His only meds are bronchodilator and steroid inhalers. On exam, BP 125/86, good skin turgor, JVP 5 cm, lungs clear, no edema. CXR shows emphysematous changes.

• A 55 year-old male smoker presents with cough. His only meds are bronchodilator and steroid inhalers. On exam, BP 125/86, good skin turgor, JVP 5 cm, lungs clear, no edema. CXR shows emphysematous changes.

• Labs:

• Na 116

• Serum osmolality 256 mOsm/kg

• Urine electroytes: Na 85 mEq/L K 78 meQ/L

• Urine osmolality 670 mOsm/kg

• The most appropriate next step in managaing this patient is:

• Order serum protein and lipids

• Chest CT

• Psychiatry consult for psychogenic poydipsia

• Administer thiazide diuretics

• Intravenous 0.9 % Na bolus