ACID-BASE BALANCE 86 year old woman is admitted
86 year old woman is admitted to the hospital after she had a seizure while waiting for swallow evaluation as outpatient. Family reports that the patient has baseline advanced dementia, which has been worsening over the last year. She is not verbal. Her Medical History: Dementia (NH resident, totally dependent in ADL/IADL Activities of Daily Living/Instrumental Activities of Daily Living), High Blood Pressure, constipation.
Her physical examination: Nothing to be noted, except dry mouth and of the mucal mucosal membranes and tachycardia. Her neurological examination revealed a somnolent, non communicative patient.
CT of the head revealed no changes since previous exam one year ago: There is no acute parenchymal hemorrhage or extra axial fluid collection. There is severe, extensive parenchymal volume loss with ex vacuo dilatation of the lateral, third, and fourth ventricles. There are confluent areas of low attenuation in the white matter diffusely, consistent with extensive chronic small vessel ischemic changes. calcifications. There is no mass, mass effect, or midline shift. There are no bony lesions nor fractures. Extensive chronic small vessel ischemic changes. BMP showed Na+ 155. The water deficit was replaced with D5W at 125 cc/hr, with a gradual drop in the sodium level to normal. The patient became more alert but continued to refuse food.
1. What do you think is going on?
2. What would you do?
3. What happened?
4. Which is the main goal of the treatment? How much fluid should you order? What type of fluid? How the correction of fluid should be made? Why?
5. What is your final diagnosis?
6. What are the risks of this condition?
7. What did we learn from this case?