An 86 year old woman is admitted to the hospital An 86 year old woman is admitte

Question

An 86 year old woman is admitted to the hospital
An 86 year old woman is admitted to the hospital

CLINICAL CASE 8 ACID-BASE BALANCE 86 year old woman is adi to the hospital after she had a seizure while waiting swallow evaluation as outpatient. Family reports that the patient has baseline dementia, which has been worsening over the last year. She is not verbal. Her Medic History: Dementia (NH resident, totally dependent in ADLIADL 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: s arenchymal hemorrhage or extra axial fluid collection. There is severe, ex 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 diffusey for no acute extensive consistent with extensive chronic small vessel ischemic changes. calcifications. no mass, mass effect, or midline shift. There are no bony lesions nor fractures. Exte chronic small vessel i There is schemic changes. BMP showed Na+ 155. The water deficit was repl aced 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 Questions 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?

Explanation / Answer

Case no 6.

1.I feel the patient is suffering from cerebral atrophy. It is a neurodegenerative disorder.

2. CT & MRI should be done to check the brain volume.

3. Main goal of treatment is to improve cognition. Psychological counseling and support, Anti convulsive drug. Mainly the patient has to take more water because fluid loss may lead to cellular dehdration which hampers the neuron activity.

4. the risks of this diseases are cerebral palsy, stroke, Alzheimer's disease.

5. we learn from this case that as we get ages we have to cultivate good habits to stay healthy and delay cerebral atrophy. Since alcoholism is the main cause for this the person has to avoid drinking alcohol. Good habits like regular exercise, eating fruits and vegetables should be adapted.

case 7.

1. it might be Acute streptococcal glomerulonephritis

2. group A beta hemolytic streptococcus is the cause for this condition.

3. sudden appearance of blood, protein, red cell casts describes the course of Acute streptococcal glomerulonephritis

4.high blood pressure, fatigue, fluid retention best describes this condition and yes the patient has a typical symptoms and signs

5. If streptococcal infection untreated for long time it mainly affects organs like kidney mainly in children resulting damaging glomerulus.

6. This course of disease is more commonly seen in childrem due to invisible hematuria and volume overload is very rare whereas it is clearly seen in adults.

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