Question

what could this 52 year old man possibly have?How the clinical history and the biochemical results aided your evaluation of the diagnosis. what is the underlying pathogenesis. What other conditions give rise to hyponatraemia and explain why these can be ruled out based on the clinical presentation.

A 52-year-old man was admitted to A&E presenting with a fever nausea and vomiting that has lasted over 2 weeks. However, in the last few days he has become irritable and confused. ON PRESENTATION Chest X-ray, ultrasound abdomen and echocardiography were all normal. Blood serum tests revealed the following: Serum analysis Test Result Reference range Sodium 125 mmol/L (135-145 mmol/L) (3.6-5.0 Potassium 4.2 mmol/L mmol/L) Chloride 100.0 mmol/L (98-107 mmol/L) Uric acid (3.0-7.2 1.4 mg/dL mg/dL) (3.3-6.7 mmol/L) (50-110 Urea Creatinine 4.7 mmol/L Omol/L 100 Omol/L) Glucose mmol/L (4.0-8.0 mmol/L) (275-295 5 Serum osmolality mOsmol/Kg) 245 mOsmol/Kg Serum cortisol 253.8 nmol/L (221-552 nmol/L) LH IU/L 1.6 (0.5-9.0 IU/L) FSH 3.4 IU/L (1.0-8.0 IU/L) GH (0.5-3.0 0.65 ug/L Hg/L) 2.5 (0.2-4.0 TSH mU/L mU/L) Free T pmol/L) pmol/L (12-25 16 Urine analysis Urinary osmolality 900 mOsmol/Kg) mosmol/Kg (300- 524 Sodium 44 mmol/L Fractional excretion 1.2% of sodium

Answer 1

Patient is suffering from bacterial meningitis.

Patient is having fever, nausea and vomiting past two weeks. In serum analysis shows decreased uric acid and serum sodium levels. But exact details get from the lumbar puncture studies, which show high protein levels and lymphocyte 90%.

Pathogenesis

Infection invades in to brain crosses blood brain barrier, invades in meningitis layers and subarachinoid spaces, covers all the CSF inflammatory response starts shows symptoms

Hyponatremia

Incompetent activity of CNS stimulates neurotransmitters which exaggerate kidneys sodium depletion and excretion