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 BOF 140

 

   

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BOF: 140

A 72 year old male was admitted with a history of agitation and confusion. He was known to have ischaemic heart disease and diet controlled diabetes. He was on aspirin and atenolol. He had been recently commenced on citalopram by his GP for anxiety and depression.  He did not smoke or drink. He was married and lived with his wife and to the point of admission had been independent in his activities of daily living.

On examination there was no oedema, he looked well hydrated, his pulse rate was 60 beats per minute regular BP 140/80 heart sounds were normal, no murmurs, lungs were clear. Apart from being confused and not oriented well in time place and person there were no neurological abnormalities.

Investigations

Hb 13.2 g/dL

WBC 7.8 x109/L

Sodium 115 mmol/L

Potassium 3.5 mmol/L

Urea 7.2 mmol/L

Glucose 6.3 mmol/L

Urinary sodium 85 mmol/L

In this patient what would be your next course of action?

a)    Fluid restriction

b)    Infuse sodium chloride

c)     Treat with demeclocycline

d)    Discontinue  atenolol

e)    Discontinue citalopram

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