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Medical Progress
Transcript
Clinical Timeline
29th August
- Transferred to Astley Ward
- Continuing PO/IV Abx
- Biochemically improving
- Sodium creeping up
- NEWS = 0
- Asymptomatic
29th
Aug
Acute retention
- Catheterised
- 600mls residual
Problem #1
Constipation
- BNO 4 days
Problem #2
Plan
- Given Glycerol suppositories
- TWOC today if BO
- MOFD pending the above
- GP to review bloods in 1 week
2nd September
Completed course of abx
Catheter still in situ
Sodium starting to fall again (124-123)
2nd
Sep
Plan
- Fluid restriction 1L
- Monitor U&Es
- Investigations
Ix
Investigations
TFT – Normal
Serum cortisol - Normal
Serum osmolality – 258 (275-295)
Urine osmolality 551 (100-1000)
Urine sodium 118
CT TAP - No malignancy
6th September
Impression - SIADH
Refer to Endocrine for plan
6th
Sep
Endocrine
- Already seen in endocrine clinic
- Formal diagnosis of SIADH
- Flares up with chest infections
Endocrine
Plan
- Tolvaptan 7.5mg if Na<125
- Remove fluid restriction
- Ensure patient is drinking well
Plan
Progress...?
- Serum sodium improving!
- Monitor UE for improvement of Na
- Consider TWOC later in the week
- For OP endocrine f/u
The pivot
13th September
Modified diet as per SALT
Plan for Monday 16th:
Reassess bloods
Consider TWOC
MOFD pending the above
13th
Sep
Failed TWOC on 11th September
Not yet...
Home time?!
- Aspiration Pneumonia
- SALT Assessment:
- Mod-severe oropharyngeal dysphagia
- Exacerbated by drowsiness
- NBM
- Requires NGT
Chest XR for NGT check
Update:
24th
Sep
- Restarted on IV co-amox
- Clinically improved
- Sodium came into normal range
- SALT Reassessment - for oral trial
- Eventually NGT was removed
- Finally MOFD?!
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