1 / 9

HYPOTHERMIA & DELIRIUM

HYPOTHERMIA & DELIRIUM. Andrew Dawson. 15.11.02 50 year old man presents to JHH 1 week history or declining mobility and increased confusion ? associated with depot injection of flupenthixol - last dose one week ago 3 days previously commenced on Cogentin 2mg bd by LMO Epilim 1gm bd.

leon
Download Presentation

HYPOTHERMIA & DELIRIUM

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HYPOTHERMIA & DELIRIUM Andrew Dawson

  2. 15.11.02 • 50 year old man presents to JHH • 1 week history or declining mobility and increased confusion • ? associated with depot injection of flupenthixol - last dose one week ago • 3 days previously commenced on Cogentin 2mg bd by LMO • Epilim 1gm bd. • PH: variety of psychiatric Dx and previous head injury • On Examination • Smelly Confused, unable to give clear account of himself • Clinically dehydrated • Pulse 80, BP 160/90, Temp - 34.7, respiratory rate 20, arterial blood gases - normal, blood sugar level - normal. • Generally hypertonic increased rigidity ? Resisting examination • brisk reflexes - no clonus,.

  3. Investigations • Haemoglobin 16, white cell count 6.7, platelets 267,prothrombin time - normal, Iron - 20, CK - 87, serum sodium 143, K 4.2, urea 3.6, creatinine -90. • Chest X-ray normal • Septic workup • normal blood cultures, • urine was found to be offensive, • white cells were > 100, red blood cells < 10, squamous < 10, profuse rods. • Commenced on Antibiotics Transferred to MMH • 8 hours later was much improved • with some mild rigidity in the right arm • no autonomic features, less flushed, no renal tenderness • No previous history of Urinary sepsis or renal disease • Continued on ampicillin and Gentamicin • the following day be was ambulant, feeding himself • Discharged well 18.11.02

  4. 23.11.02 • Represents to JHH - wife states he has had decreased mobility over the last 3-4 days despite being recommenced on Cogentin. ???? Further antipsychotics since his last admission. Wife claims that he has difficulty swallowing and of pain in the throat. • On examination - conscious, orientated to time and place, GCS - 15, BP - 175/100, Pulse 95, Temp - 37, saturations 98%, respiratory rate - 22. • Generally hyper-reflexic • cardiovascular and respiratory examination was normal uvula was noted to be erythematous and red with small white plaques, tongue was dry, white and furry. Provisional diagnosis • dehydration • upper respiratory tract infection, throat tonsillitis • drug reaction

  5. Investigations • Sodium -129 Potassium - 46 Chloride - 94 Bi-carb - 23 Urea - 4.8 Creatine - 89 Liver functions tests - normal CPK - 2083 • Reviewed by ENT Registrar - noted ? Uvular, no pharyngitis or tonsillitis, oral cavity pathology does not seem likely serology for symptoms for this medical review.

  6. Three hours later seen by medical registrar - noted to be drowsy, dehydrated and sweating. • Temp - 36.6, BP 170/110 • rigidity noted bilaterally • increased reflexes • ? Diagnosis - transferred to Mater Hospital

  7. Mater Hospital • Physical examination unchanged • Heart rate - 94 • BP 199/90 • Serum sodium 124 • CPK - 453 2200 reviewed by Consultant • Marked rigidity • Pill rolling tremor • fluctuating temp noted • diaphoresis not related to temperature • >20% Fluctuation in BP • No evidence of sepsis • 24/11 commence on Bromocriptine 5mg 4th hourly • Urine analysis and electrolytes performed

  8. 25/11/02 • Clinical am • BP flux resolved • Stiff, sweating and delirium • Osmolarity • Plasma 261 mmol/kg • Urine 927 mmol/kg • Family interview • wife 4 brothers 2 sisters and a couple of mates • Medical diagnosis • Psychiatric diagnosis • Risk of further medications • E.coli in urine

  9. Progress • 26/11/02 • Clinical • Minimal rigidity, moving freely, feeding self and smoking • Afebrile, no autonomic instability • Delirium • Reduce bromocriptine dose • 27/11/02 • RMO asked to see patient because of increased urine output • 630 ml in 3 hours (between midnight and 3 am) • Subsequently weaned from bromocriptine over the next 4 weeks

More Related