A new chapter

Hyponatremia chapter written by Vigor Arva and Gregor Prosen from Slovenia is just uploaded to the Website!

Bohermeen Spring Half Marathon 2014

A 72-year-old man was brought to the emergency department by his daughter. She reported that he had nausea, vomiting, and confusion and had been unwell for the last few days. He had hypertension and heart failure for the previous ten years and was on ACE-inhibitor, beta-blocker and thiazide diuretic.

At triage, the patient’s vital signs were usual: blood pressure 110 over 70 mmHg, heart rate 95/min, respiratory 15/min, temperature 36.1°C and SpO2 100% on room air. He appeared lethargic and walked with an unsteady gait. He had no focal neurological deficit. He had a normal skin turgor and no edema. Postural BP revealed mild orthostatic hypotension. The lab results showed a serum sodium concentration of 115 mEq/L.

slovenia
by Vigor Arva and Gregor Prosen.

Do you have 9 minutes 40 seconds?

Hypernatremia chapter written by Vigor Arva and Gregor Prosen from Slovenia is just uploaded to the Website!

Pink Salt ^w^

A 79-year-old man was brought to the emergency department (ED) by his wife. She complained that the patient had general weakness and was feeling ‘unwell’ for the last two days. He had a history of dementia, diabetes, renal failure, and hypertension. He was on diabetic and antihypertensive medication.

On examination, his vital signs were as follow HR 115/min, BP 135/90 mmHg, RR 17/min, and afebrile with normal oxygen saturation. He was confused and disoriented, but there was no other deficits or localizing signs on neurological exam. He was clinically dehydrated with dry oral mucosa. Lab results showed a serum sodium concentration of 160 mEq/L, with elevated glucose, creatinine, urea, and osmolality. Point of care ultrasound demonstrated a small and almost totally-collapsed inferior vena cava. Upon further history taking, the patient’s wife reported that he had not been drinking much for the last few days, even though he did not complain about thirst.

slovenia
by Vigor Arva and Gregor Prosen from Slovenia