Question

Mr. Williams is a 69 year old male who arrived at the emergency department, complaining of severe vomiting & weakness for two days. Identifying Information: 69 yr old male History of Present illness: 69 yr old male presented to the ED c/o of severe vomiting & weakness for two days. He states he has taken the medications for vomiting but can't hold anything down. He feels dizzy when standing up and feels very weak. Currently being treated for tongue cancer. He is on cycle 3/5 of chemotherapy & radiation. Past Medical History: Hypertension Gout Past Surgical History: Surgical resection-base of tongue Current Medications: • Lisinopril-hypertension . Colchicine-gout • Ondansetron-nausea Chemotherapy combined with radiation x7days-every other week for 5 weeks o 5-fluorouracil (5-FU) o cisplatin • Hydroxurea • Magic mouthwash-stomatitis & mucositis Allergies: No allergies Family History: Mother-deceased-breast cancer, hypertension, Alzheimer's disease Father-deceased-CAD, hypertension, myocardial infarction, heart failure Social History: Occupation: retired auto factory worker Tobacco Use: everyday Illicit Drug Use: never Alcohol Use: occasional use Review of Systems: (what patient tells you) Skin: pain & itching to face & neck, no changes in hair, no changes with nails Mental Health: no current feelings of sadness, no sleep disturbances, no suicidal ideations Neurological: + light-headedness,+ dizziness,+paresthesia to feet & hands, no balance problems Head and neck: no headache, no neck pain, no stiffness, minimal swelling to radiation burns

Answer 1

1. Based on the patients manifestations , the diagnosis are :-

Fluid imbalance - Hypovolemia

Electrolyte imbalance - Hyponatremia , Hypokalemia , Hypomagnesemia

Acid base imbalance - Metabolic alkalosis

2. Manifestations :-

Fluid imbalance - weakness , dry mucous membrane

Electrolyte imbalance - weakness , lightheadedness , dizziness, paresthesia to feets and hands , tachycardia , hyperreflexia

Acid base imbalance - confusion ,tremor , lightheadedness ,nausea, vomiting, numbness or tingling in the face, hands, or feet.

3. Diagnostic test to be used are :-

Fluid imbalance - CBC, LFT, BMP , Urine analysis

Electrolyte imbalance - LFT, RFT, VBG ABG

Acid -base imbalance - ABG

4. The electrolyte imbalance causing seizures is Hyponatremia.