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A 41-year-old man is admitted to the hospital for progressive obtundation. On admission the patient’s serum sodium level is 114 mEq/L. Treatment is initiated, and seven hours later the patient’s serum sodium level is 134 mEq/L. Over the next four days the patient’s condition worsens with the development of dysarthria, dysphagia and paraparesis. What pathologic process is most likely responsible?
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