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We didn t implement the <= or >= methods in this example, but you should go ahead and try it on your own. Solution to Exercise 12-4. Create a class Foot and a class Meter. Each should have a single parameter that stores the length of the object, and a simple method to output that length. Create a casting operator for each class: one that converts a Foot object to a Meter object, and one that converts a Meter object to a Foot object. Test these operators to make sure they work. First, it should be said that the Foot and Meter classes don t make a lot of sense in the real world. It would most likely be better to create a class Measurement, or something similar, that could output the length in either feet or meters. Still, you ve got two classes, so you should be able to convert between them. Since you re using two userdefined classes here, you won t be able to write an implicit conversion. Therefore, Foot needs an explicit conversion to Meter, and Meter needs an explicit conversion to Foot. For example, here s the declaration for the Foot class s conversion to Meter:

The initial approach to its investigation is the determination of serum osmolality (Figure 21 1) Although most cases of hyponatremia result from water imbalance, not sodium imbalance, measurement of urine sodium helps distinguish renal from nonrenal causes of hyponatremia Urine sodium exceeding 20 mEq/L is consistent with renal salt wasting (diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), mineralocorticoid deficiency, saltlosing nephropathy) Urine sodium less than 10 mEq/L or fractional excretion of sodium less than 1% (unless diuretics have been given) implies avid sodium retention by the kidney to compensate for extrarenal fluid losses from vomiting, diarrhea, sweating, or third-spacing, as with ascites

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Assessment of ECF volume and serum osmolality are essential to determine etiology Hyponatremia usually reflects excessive water retention relative to sodium rather than sodium deficiency Hospitalized patients treated with hypotonic fluid are at increased risk for the development of hyponatremia Treatment strategy should be based not only on pathophysiology but also on the severity and speed of development

Hyponatremia (defined as a serum sodium concentration less than 130 mEq/L) is the most common electrolyte abnormality observed in a general hospitalized population, seen in approximately 20% of patients

public static explicit operator Meter(Foot theFoot)

Mass Conversion 23 mg = 1 mEq 39 mg = 1 mEq 35 mg = 1 mEq 61 mg = 1 mEq 40 mg = 1 mmol 31 mg = 1 mmol 24 mg = 1 mmol

135 145 mEq/L 35 5 mEq/L 98 107 mEq/L 22 28 mEq/L 85 105 mg/dL 25 45 mg/dL 16 3 mg/dL 280 295 mosm/kg

Isotonic and hypertonic hyponatremia should be initially ruled out by determining serum osmolality, blood lipids, and blood glucose Isotonic hyponatremia can be seen with hyperlipidemia and hyperproteinemia Because of marked increases, lipids (chylomicrons; triglycerides, which make the blood visibly lipemic; and very occasionally cholesterol, which may not make the blood visibly lipemic) and proteins (> 10 g/dL, eg, intravenous immunoglobulin therapy) occupy a disproportionately large portion of the plasma volume Plasma osmolality remains normal because its measurement is unaffected by the lipids or proteins A decreased volume of water results, so that the sodium concentration in total plasma volume is decreased Because the sodium concentration in the plasma water is actually normal, hyperlipidemia and hyperproteinemia cause so-called pseudohyponatremia Most laboratories measure serum electrolytes using ion-specific electrodes and thus avoid misdiagnosis unless dilution of samples is needed before direct measurement Hypertonic hyponatremia is most commonly seen with hyperglycemia When blood glucose becomes acutely elevated, water is drawn from the cells into the extracellular space, diluting the serum sodium The plasma sodium level falls 2 mEq/L for every 100 mg/dL rise when the glucose concentration is between 200 and 400 mg/dL If the glucose concentration is above 400 mg/dL, the plasma sodium concentration falls 4 mEq/L for every 100 mg/dL rise in glucose This dilutional or translocational hyponatremia is not pseudohyponatremia, since the sodium concentration does indeed fall Infusion of hypertonic solutions containing osmotically active osmoles (eg, mannitol) may also cause hypertonic hyponatremia by drawing water to the extracellular space

Note that this operator is public, static, and explicit. The body of the operator method isn t really challenging, but remember that it should return an object of class Meter. The Meter class operator is similar. Example A-33 shows one way to do it.

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