SAQ 719 – Metabolic – severe hyponatraemia with seizures

A 78-year-old man is brought to the ED with confusion and lethargy.

Initial point-of-care testing shows: sodium 113 mmol/L, potassium 4.9 mmol/L, ionised calcium 1.21 mmol/L, haematocrit 40% PCV and haemoglobin 10.1 g/dL.

List six (6) other laboratory investigations that would help identify the cause of the most significant abnormality.

(Marked out of 6.0)

/ 6

Complete the table by listing a laboratory investigation that helps distinguish causes by clinical volume status, and give two (2) causes for elevated and reduced results.

(Marked out of 9.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Volume status</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Laboratory investigation / result</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Causes</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Hypovolaemia – elevated</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Hypovolaemia – reduced</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Euvolaemia – elevated/normal</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Euvolaemia – reduced</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Hypervolaemia – elevated</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Hypervolaemia – reduced</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 9

He deteriorates and begins to convulse. Other than routine seizure management, what specific treatment should be started and how should it be administered?

(Marked out of 2.0)

/ 2

What is the endpoint aim of this treatment?

(Marked out of 1.0)

/ 1

Total Score: 0 / 18

Percentage: 0%