“Multiple medical concerns to consider…” Case Conclusion October 4, 2012
Posted by Andy Jagoda, MD in: Hematologic/Allergic/Endocrine Emergencies , trackback
Your elderly patient had multiple medical concerns that required emergent evaluation. You diagnosed her with severe hypernatremia, likely secondary to her underlying disease processes, combined with a lack of access to free water. In addition to her pneumonia, she had been having gastrointestinal losses from vomiting, along with her known underlying renal insufficiency. On arrival, she was hypotensive and febrile. You immediately established 2 large-bore IVs, placed her on 2 L oxygen via nasal cannula, and obtained a finger-stick blood glucose. You began her management by correcting her hypoperfusion and hypovolemia with a 500- mL NS bolus followed by a second 500-mL NS bolus for her persistent hypotension after the pulmonary exam and confirmation of her past medical history. You then began treatment of the underlying causes of her hypernatremia with antipyretics, antiemetics, and antibiotics for her fever, vomiting, and pneumonia, respectively. After 2 NS boluses, her vital signs normalized, and slow correction of hypernatremia was initiated with 1/2NS at 100 mL/h over 48 hours as an inpatient.
Congratulations to Dr. Kui, Dr. JV, Dr. Di Giammarco, Dr. Kleinsteuber, and Dr. Flanagan— this month’s winners of the exclusive discount coupon for Emergency Medicine Practice. For an evidence-based review of the etiology, differential diagnosis, and diagnostic studies for Sodium Disorders In The Emergency Department: A Review Of Hyponatremia And Hypernatremia, purchase the Emergency Medicine Practice issue.