mobey Posted June 12, 2009 Share Posted June 12, 2009 calculate serum osmolality, would these findings be available? (I do notice the BGL of 6.) The serum sodium would be of particular interest. Take care, chbare. This is waaay over my head, but are you thinking Cerebral Edema? Link to comment Share on other sites More sharing options...
chbare Posted June 12, 2009 Share Posted June 12, 2009 This is waaay over my head, but are you thinking Cerebral Edema? Yep. Take care, chbare. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 12, 2009 Author Share Posted June 12, 2009 Serum osm 200 mOsm/Kg water CSF osm > serum (unable to find a normal range) Urine NA is 40 mEq/l Urine osm is 250 mOsm/Kg FENa .14% (0.14) UP Creat 150 (1.5 mg/dl) Preg neg BAC 0 ml/dl BGL 6 mmol/l or 108ml/dl Link to comment Share on other sites More sharing options...
zzyzx Posted June 12, 2009 Share Posted June 12, 2009 Do these labs indicate kidney failure? If that's the case, then she may be having a hypertensive crisis that is causing cerebral edema or infarction. Perhaps all this began with a UTI and lead to a kidney infection? I really need to learn lab values! Hopefully I'll be in nursing school in a few months. Link to comment Share on other sites More sharing options...
chbare Posted June 12, 2009 Share Posted June 12, 2009 Do these labs indicate kidney failure? If that's the case, then she may be having a hypertensive crisis that is causing cerebral edema or infarction. Perhaps all this began with a UTI and lead to a kidney infection? I really need to learn lab values! Hopefully I'll be in nursing school in a few months. Potentially, the creatinine is elevated; however,I would like a BUN as well. My concern is the serum osmolality. This is in fact a significant lab value. Like ERDoc, I would like to see at least a chem-7/BMP to get an idea of the electrolytes, specifically the sodium. Additionally, we could use the additional findings to calculate the predicted serum osmolality, then compare to the actual. If a significant gap exists, we need to look at causative substances. In addition, a drug screen may be helpful. The history and limited lab data along with ECG findings lead me to believe that an electrolyte imbalance is the potential cause of the seizures. The root cause may be related to the use of certain illicit substances. Take care, chbare. Link to comment Share on other sites More sharing options...
zzyzx Posted June 13, 2009 Share Posted June 13, 2009 Yeah, drug screen would be important. The title "dancing queen" makes me think of ecstasy. Some kids who use that stuff drink way too much water because they are afraid of becoming dehydrated. Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2009 Share Posted June 13, 2009 Yeah, drug screen would be important. The title "dancing queen" makes me think of ecstasy. Some kids who use that stuff drink way too much water because they are afraid of becoming dehydrated. In addition, some people think MDMA can cause increased levels of ADH. This will cause the body to retain water and set the person up for "dilutional hyponatremia." Take care, chbare. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 13, 2009 Author Share Posted June 13, 2009 BUN: 4 mg/dL CO2 (carbon dioxide): 25 mmol/L Creatinine: 1.3 mg/dL Glucose: 110 mg/dL Serum chloride: 105 mmol/L Serum potassium: 4 mEq/L Serum sodium: 90mEq/L Serum osm 200 mOsm/Kg water CSF osm > serum (unable to find a normal range) Urine NA is 40 mEq/l Urine osm is 250 mOsm/Kg FENa .14% (0.14) UP Creat 150 (1.5 mg/dl) Preg neg BAC 0 ml/dl BGL 6 mmol/l or 108ml/dl If you would like the answer; it is below Syndrome of inappropriate ADH retnetion, hyponatremia, increased ICP (cerebral edema), seizure Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2009 Share Posted June 13, 2009 Holy cow, look at that sodium! Assuming no drug abuse, we have to look at the possibility of a pituitary problem or perhaps small cell carcinoma. Take care, chbare. Link to comment Share on other sites More sharing options...
Happiness Posted June 13, 2009 Share Posted June 13, 2009 Ok I am probably right off base here but the statement of unable to pee can be different that unable to create pee. So Im going with a blockage or detachment of the bladder. If you cant get rid of urine all sorts of things can happen. Link to comment Share on other sites More sharing options...
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