A worried set of parents bring their 15-year-old high
school student daughter to see you because she is not feeling well. Her parents
report that she has been trying to diet to lose weight. Her past medical history and the family history is negative, and you find no abnormalities on an initial physical
examination. Lab tests show: Na+ 127 mEq/L, K+ 3.9 mEq/L, Cl- 96 mEq/L,
HCO3- 23 mEq/L, BUN 7 mg/dL, and Cr 0.5 mg/dL.
The urine specific gravity is 1.001 and the urine osmolality is 56
mOsm/kg.
What is the most likely explanation for her hyponatremia?
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