A 86 YEAR OLD MALE WITH HYPONATREMIA

YNavya sahithi Reddy
Roll.no : 146

ICU CASE.
March 7 2022
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



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