question: Q:A 23-year-old woman presents to her primary care physician for poor sleep. Her symptoms began approximately 1 week ago, when she started waking up multiple times throughout the night to urinate. She also reports an increase in her water intake for the past few days prior to presentation, as well as larger urine volumes than normal. Medical history is significant for asthma. Family history is significant for type 2 diabetes mellitus. She denies alcohol, illicit drug, or cigarette use. Her temperature is 98.6°F (37°C), blood pressure is 108/65 mmHg, pulse is 103/min, and respirations are 18/min. On physical exam, she has mildly dry mucous membranes and has no focal neurological deficits. Laboratory testing demonstrates the following:
  
  Serum:
  Na+: 145 mEq/L
  Cl-: 102 mEq/L
  K+: 4.2 mEq/L
  HCO3-: 28 mEq/L
  BUN: 15 mg/dL
  Glucose: 98 mg/dL
  Creatinine: 0.92 mg/dL
  
  Urine:
  Urine osmolality: 250 mOsm/kg
  
  The patient undergoes a water deprivation test, and her labs demonstrate the following:
  
  Na+: 147 mEq/L
  Cl-: 103 mEq/L
  K+: 4.4 mEq/L
  HCO3-: 22 mEq/L
  BUN: 16 mg/dL
  Glucose: 101 mg/dL
  Creatinine: 0.94 mg/dL
  
  Urine osmolality: 252 mOsm/kg
  
  Which of the following is the best next step in management?? 
  {'A': 'Counsel to decrease excess water intake', 'B': 'Desmopressin', 'C': 'Dietary modification', 'D': 'Intravenous fluids', 'E': 'Metformin'},