Q:

What other clinical history, examination and investigation would be relevant?

0

A 64-year-old male presents to the emergency with progressive altered behavior for 10 days, and seizures 1 day back. He is a known diabetic for 20 years and hypertensive. BP 140/90, RBS 130 mg, creatinine 1.2 mEq/L, Na 110 mEq/L, K 5.0. There is no history of seizures and CT head is normal. How would you evaluate this patient?

What other clinical history, examination and investigation would be relevant?

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History of:

• Vomiting, diarrhea,

• Drug intake (e.g. diuretics, etc.)

• Oliguria, swelling over feet or face

• Dyspnea, cardiac illness

Examination:

• Signs of dehydration (skin turgor, tongue, etc.)

• Anasarca

• Blood pressure (supine and postural)

• Pulse rate

• Systemic examination for cardiac, renal or liver disease

• Neurological examination

Investigation:

• Urinary sodium and creatinine

• Blood glucose

• Renal function

• Thyroid function

• Cortisol

• Plasma and urine osmolality.

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