A 70-year-old woman with a history of knee osteoarthritis with mucous diarrhea for a year was admitted to our hospital for shortness of breath. Her physical examination and vital signs were normal. Chest computed tomography and cardiac ultrasound were normal. Serum creatinine and blood urea nitrogen were 2.31 and 66.4 mg/dL, respectively. Serum sodium, chloride, and potassium were 135.1, 83.7, and 2.7 mEq/L, respectively. Her endocrine functions including free hyroxine and thyroid-stimulating hormone were normal. Blood gas analysis revealed pH7.5, PO 2 69.2Torr, PCO 2 43.5Torr, BE9.4 mEq/l, HCO 3 33.7 mEq/L. Abdominal computed tomography showed a large protruded tumor in the

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