Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Emergency Department Management of Knee Pain correct.
Case Presentation: Sodium Disorders in the Emergency Department: A Review of Hypernatremia and Hyponatremia
A 93-year-old man with a history of dementia, diabetes, and hypertension arrives from a skilled nursing facility for confusion and weakness…
- The patient has had diarrhea and vomiting for the previous 4 days. Current medications include metformin, hydrochlorothiazide, lisinopril, and aspirin.
- His vital signs on arrival in the ED are: oral temperature, 38.7°C; heart rate, 114 beats/min; blood pressure, 86/53 mm Hg; respiratory rate, 24 breaths/min; and oxygen saturation, 94% on 3 L nasal cannula.
- On physical examination, he is cachectic, with dry oral mucous membranes, and is reportedly more confused than his baseline. His abdomen is soft and nontender, with no rebound or guarding. However, he does have an episode of nonbloody, nonbilious emesis during your examination.
- Blood is obtained, and a serum chemistry panel shows: sodium, 154 mEq/L; potassium, 3.9 mEq/L; chloride, 108 mEq/L; bicarbonate, 14 mEq/L; BUN, 55 mg/dL; creatinine, 2.0 mg/dL; and glucose, 112 mg/dL. The nurse asks you what IV fluids you want and how fast…
Make your best guess, and check back next month to find out the correct answer!
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