Please help me answering the following questions for this clinical case Mr. Gutt

Question

Please help me answering the following questions for this clinical case

Mr. Gutteman, a 70 –year-old male was brought into the ER in a comatose state.

He had suffered severe head trauma (his scalp was badly lacerated and he has an impacted skull fracture. His fracture was repaired.

On the 2nd day of his hospitalization, the aide reports that Mr. Guttemann:

            Is breathing irregularly,

            his skin is dry and flaccid, and that

            She has emptied his urine reservoir several times during the day.

            Mr. Gutteman’s blood and urine tests are negative for glucose and ketones.

            He is found to be losing huge amounts of water in urine and the column lost is being routinely replaced (via IV line)

Questions

1.         What is Mr. Gutteman’s hormonal problem?

2.         Where is the lesion located?

3.         What do you think caused it?

4.         Is it life threatening?

5.         Why Mr. Gutteman’s water balance would be challenging if the lesion is located in hypothalamus?

Explanation / Answer

He is in unconscious state and this is medical emergency. This type of situation mainly arises due to stroke, traumatic brain injury, drug intoxication, hypoglycaemia and hypoxia. In this case, level of damage to his brain is unclear. Monitoring and care of his responses and vital signs will provide exact information about his injuries.

In 2nd day of hospitalization, on the basis of symptoms, patient condition could be termed as diabetes insipidus, a condition in which insufficient quantities of antidiuretic hormone (ADH) are produced or released. In this condition, patients excrete large volumes of urine but do not possess glucose or ketones in the urine.
Injury in head could have damaged his hypothalamus and due to this damage hypothalamus produces insufficient amount of ADH hormone releasing factor which is necessary to activate posterior pituitary gland, which releases ADH into the bloodstream.

This condition is not life threatening but depends on disease severity. Although, he is unable to tell or preform the skill on his own, and to prevent dehydration on it's own and may cause mental retardants.

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