USOM I Case 1

73 y/o F w/ hx of hyperlipidemia, IDDM, and prior smoking hx presents with her daughter reporting weakness in the setting of 1 week of nausea and vomiting.  She is also reporting difficulty with motor functions including walking and picking up objects such as the morning paper and her afternoon teacup.  Her exam is significant for global weakness and ataxia, however the pt is noted to be conversing normally with her daughter in the room.

Basic metabolic panel: Na+ 105, K+ 3.2, Cl 98, CO2 18, BUN 35, Cr 1.5, Glu 200
Complete blood count: wbc 8, hct 33, hbg 11.5, plt 150
Remaining labs are pending

What’s the diagnosis and what treatment do you want to initiate? 

To better establish the patient’s fluid status you perform the following ultrasound: Case 1 Ultrasound

Is the patient hypovolemic, euvolemic, or hypervolemic? How can you tell? 

The following labs return: Serum osmolality 256 mosmol/kg, urine sodium 10 meq/L, urine osmolality 400 mosmol/kg

Charge nurse calls: no beds are available in the hospital and none are anticipated to be ready until 7 am (7 hours from now).

You decide to initiate treatment for this patient’s condition. What do you give and what’s your target goal? 

Before initiating treatment, the patient begins to have a tonic-clonic seizure. What do you give?