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Post by DD on Aug 27, 2015 17:28:54 GMT -5
50 year old comes in from a nursing home/assisted living setup with shortness of breath. Satting around 80% off oxygen, doesn't normally wear oxygen. He seems slightly developmentally delayed but still answers all your questions appropriately. No chest pain. He has a history of two prior MI's. No history of CHF. He improves on oxygen and is now satting upper 90s, now only in mild distress. Put him on bipap and he's golden. X-Ray:  EKG:  BNP: 10,000 Lab calls you and tells you his sodium is 109. Repeat sodium is also 109. All other tests negative including troponin. I walk into the room and ask him one question and have my diagnosis. What question did I ask and what's the diagnosis? |
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Post by tyson on Aug 28, 2015 11:12:20 GMT -5
I don't know how you get around calling that anything other than congestive heart failure. You would expect hyponatremia in decompensated heart failure as bnp, when released from stretched heart causes naturesis. Positive pressure support would also support this viewpoint of chf.
Was there edema and jvd?
What else am I missing here?
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Post by tyson on Aug 28, 2015 11:13:34 GMT -5
Heart on x Ray is massive.
Don't see a ton of fluid on lungs.
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Post by jpollock on Aug 28, 2015 17:51:50 GMT -5
are you thirsty?
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Post by erinto on Aug 29, 2015 8:34:11 GMT -5
How much water have you been drinking? Do you constantly feel thirsty?
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Post by DD on Sept 1, 2015 5:18:55 GMT -5
Bingo! Psychogenic polydipsia causing CHF.
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Post by pbruss on Sept 3, 2015 13:48:40 GMT -5
interesting. do you think lung ca could aslo be in the differental? signs of right atrial enlargment with possible mass on cxr? he get a scan of his chest?
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Post by DD on Sept 3, 2015 21:01:23 GMT -5
interesting. do you think lung ca could aslo be in the differental? signs of right atrial enlargment with possible mass on cxr? he get a scan of his chest? Yeah, I looked for a PE, nothing. Also the radiologist told me to scan his belly because the inferior cuts showed a large amount of hydro, turns out he was just drinking so much water his kidneys were working overtime. BUN/cr were next to nothing. |
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