A 78-year-old woman is brought to the ED with confusion after taking bowel preparation for a colonoscopy due the next day. Her husband reports she has been drinking lots of fluid and passing copious urine. On arrival she is mumbling but cooperative and has increased tone in all limbs.
Vital signs are HR 80/min, BP 140/90, temperature 37 degrees C and RR 20/min. She weighs 70 kg. Her blood results are shown below. Within 30 minutes of arrival she has a 2-minute tonic-clonic seizure that stops spontaneously. You decide to use 3% hypertonic saline because it is readily available in your ED.
| Test |
Result |
Reference range |
| Na |
110 mmol/L |
135-145 |
| K |
2.9 mmol/L |
3.5-4.5 |
| Cl |
62 mmol/L |
95-110 |
| Urea |
3.6 mmol/L |
2.9-7.1 |
| Creatinine |
50 micromol/L |
45-90 |
| Glucose |
5.0 mmol/L |
3.0-6.0 |
Indicate the three (3) investigations pertinent to investigating hyponatraemia in this patient.
(Marked out of 3.0)
/ 3
Indicate how you would determine the cause of her hyponatraemia from the investigation results and history.
(Marked out of 3.0)
/ 3
Outline your approach to 3% hypertonic saline correction.
(Marked out of 4.0)
/ 4
Total Score: 0 / 10
Percentage: 0%
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