Campus Conundrum

[CAO]

Brown will have to start posting harder scenarios ......

Ooh! Please do. I get a lot reading through these and seeing everyone's thought processes.

Just to make sure I understand something, the elevated BP was from when her body recognized the lowered sodium and attempted to conserve whatever it could by slowing down and stopping its excretion, which would also result in excess fluid being retained, right?

 

[jrm818]

Ooh! Please do. I get a lot reading through these and seeing everyone's thought processes.

Just to make sure I understand something, the elevated BP was from when her body recognized the lowered sodium and attempted to conserve whatever it could by slowing down and stopping its excretion, which would also result in excess fluid being retained, right?

Actually I'm not so sure about that explanation. That would be the normal response to hyponatremia, but the urine of this patient was rather dilute (about as dilute as their body serum) which does not indicate the sort of conservation you suggest. It was that reason that I suggested an obstructive cause to the low flow - I figured physiologically low urine output would produce very concentrated urine, so this must not be physiological, and obstruction was the other source of low flow that occured to me. Renal artery issues were the other, but given the lack of pain and young-ness of this pt., that seemed unlikely to me.

I was going with a osmotic dilution source of hyponatremia - e.g. the pt. was retaining most of their body water which produced the extremely dilute serum as shown in the lab results. Combined with some of Meclin's proposed improper diet this could produce pretty severe electrolytic derangement.

At least that was my guess, but I'm still worry that I'm a bit off on the explanation.

Paging doctor brown. The natives are getting restless for an answer...

 

[MrBrown]

Paging doctor brown. The natives are getting restless for an answer...

Oh damn it to the bowels of bloody hell .... fine

*Brown crawls out from under the wreckage of the road traffic accident and dusts off his jumpsuit. Oz, be a dear, let me know when the suxamethonium has worn off then shove in an LMA I have to go answer my pager ....

It was hyponatremia and syndrome of inappropriate ADH retention causing cereberal edema and seizure.

Patient was taken with much of the fastness to hospital where the people in blue scrubs had a fossik around in her noggin.

 

[lightsandsirens5]

Oh damn it to the bowels of bloody hell .... fine

*Brown crawls out from under the wreckage of the road traffic accident and dusts off his jumpsuit. Oz, be a dear, let me know when the suxamethonium has worn off then shove in an LMA I have to go answer my pager ....

It was hyponatremia and syndrome of inappropriate ADH retention causing cereberal edema and seizure.

Patient was taken with much of the fastness to hospital where the people in blue scrubs had a fossik around in her noggin.

But what was the causation? Or do we even know?

 

[MrBrown]

Wouldnt suprise me if it was MDMA

 

[jrm818]

Oh damn it to the bowels of bloody hell .... fine

It was hyponatremia and syndrome of inappropriate ADH retention causing cereberal edema and seizure.

Rats - I had convinced myself that her urine wasn't concentrated enough to be SIADH. I was all happy with myself for coming up with the obstructive guess on my own and then finding out it was a real possibility thanks to google. Guess not...

Any clue what they did treatment-wise for her? Any thoughts on how the pre-hospital treatment could have changed?

Great scenario, thanks for posting it. You can go back to whirly-bird now...

 

[ke5kce]

If hospital is a twenty minute drive away, no I would not call on the helicopter. By the time the crew gets out to the bird and wound up, I could be trucking down the road. High flow O2 and diesel.

 

[Aidey]

If hospital is a twenty minute drive away, no I would not call on the helicopter. By the time the crew gets out to the bird and wound up, I could be trucking down the road. High flow O2 and diesel.

Why? She is 98% on RA.

 

[jrm818]

Why? She is 98% on RA.

to get her to 99!

99>98



http://www.youtube.com/watch?v=UeOXsA8sp_E&feature=related

 

[CAO]

I'd have her on 2 liters, but that's only because the hospital would complain if I didn't have her on anything when I dropped her off.

Oxygen is a drug, and it has effects. Had this argument in class tonight, and it lasted way too long.

What's that sound? I think it's Brown slamming his head into his desk from half a world away since the topic is still going, haha.

 

[juxtin1987]

Haven't been on here in a while and realize this post is a bit old but i'm backlogging to make up for lost time.

Just wanted to say that i dont buy this scenario one bit. Frat girl, 20 means second year of college found at a party so lets assume regular alcohol intake which makes MDMA next to impossible.

Am I wrong?

 

[Melclin]

Am I wrong?

Absolutely.

Why would drinking stop a person from taking MDMA?

 

[MrBrown]

Just wanted to say that i dont buy this scenario one bit. Frat girl, 20 means second year of college found at a party so lets assume regular alcohol intake which makes MDMA next to impossible.

Am I wrong?

Yes, dont read into that 100 hour course you took too much there mate

 

[juxtin1987]

Yes, dont read into that 100 hour course you took too much there mate

That was meant to be ironic. Hyponatremia from MDMA's alone is a fairly common cause of demise in a frat house setting and the alcohol intake would only exacerbate said chance of demise.

AND Don't knock my 100 hour course Mr. Brown, everyone started with good intentions and a 100 hour course.

 

[Melclin]

AND Don't knock my 100 hour course Mr. Brown, everyone started with good intentions and a 100 hour course.

No not everyone.

You whats unfortunate about your 100 hour course? It produces a bunch of providers so remarkably stupid that others make the mistake of thinking that a self evidently absurd comment, made in jest, was actually intended to be serious. Stupider things have been said here that were entirely serious. Apologies for my lapse in sarcasm detection

 

[juxtin1987]

Stupider things have been said here that were entirely serious.

This scares me :unsure: