86 YEAR OLD MALE WITH HYPONATREMIA

 

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT .

A 86 year old male patient came to the opd with cheif complaints of

1.Excessive sleepiness since 1 week

2.contraction of all four limbs since 1week

3.slurring of speech since 1 week

4.fever since 4 days.

HOPI:

Patient was apparently asymptomatic 3months back then he dveloped blackish discolouration of right 4th toe and developed ulcer which is incidious in onset and gradually progressive and toe amputation was suggested.there was decreased intake of food and loss of appetite and unable to identify his family members. 20 days back then he developed bilateral swelling of knee joint then he was taken to the nearby hospital and they gave conservative management. He also developed hypertonia of four limbs ,sluuring of speech, and exceesive sleepiness since 1 week.

PAST HISTORY: 

He was a known case of diabetes ,hypertension since 10 years. He had a history of umblical hernia.

Personal history:

Diet : mixed diet

Sleep: excessive sleepiness

Regular bladder and bowel movements

Addictions: alcohol daily 90 to 150ml

GENERAL EXAMINATION : 

Patient was in state of drowsiness, consiousness, and confused,cooperative not oriented to space and time

Vitals:

Bp :150/90 mmof hg

Pulse: 109 bpm

Temperature:99 F (fever spikes) positive

Spo2 : 98.

Systemic examination.:

Respiratory system 

1.BAE +ve

2.diffuse wheezing +ve.

Cvs.

S1 and s2 heard

CNS:

Pupils - pseudophakia positive both rt and lf

Tone : rt lf

 Upper limb : increased incresaed

Lower limb : increased increased

Power: rt lf

UL : 2/5 2/5

Ll: 2/5 2/5

Reflxes : biceps, trices, supinators,ankle ,knee,plantars

Rt - 2+,2+,2+,2+,2+,2+,2+ extended.

Lf- all are 2+ - extended

plasma osmalality : 269

TRUE HYPONATREMIA

HYPOVOLEMIA(2⁰ to drug induced)

MRI OF BRAIN:

2D Echo:

ECG :

Ultrasound findings:

1) cholelithiasis

2) left ectopic kidney

3) umblical hernia

provisional diagnosis:

 A 86 year old male patient evaluated with hyponatremia and hypovolemic.

Treatment:

1.head end elevation

2.inj pantop 40 mg dsr i.v OD

3.i.v f with0.9% Normal saline .50ml@hr

4.inj monocef

5.syrup ascoril

6.RT feeds 2 hrly with 100ml of milk with protein

And free water 50ml / hr

7.temperature chart 4hrly

8.vitals monitoring.