Reference no: EM133541242
Scenario:
A 73-year-old man presents to the emergency department with altered mental status following a car accident 3 days ago. He sustained a head injury but refused to go to the hospital at that time. Per reports from his wife who accompanied him to the emergency department, the patient has been acting confused and disoriented since the accident, with worsening symptoms in the past 24 hours. Laboratory evaluation reveals hyponatremia (serum sodium 112 mEq/L), high urinary sodium concentration, low serum uric acid level, and normal renal function findings that are consistent with SIADH. The cause of SIADH in this patient is likely head trauma, but students should also consider the possibility of drug-induced SIADH. In this patient, that would include the use of fluoxetine, an SSRI. The serum sodium concentration should be gradually normalized over the next 2-3 days. Fluid restriction, hypertonic (3%) saline, and furosemide may be required acutely. Treatment with a vasopressin receptor antagonist is not first-line therapy; however, use may be considered when standard of care therapy is not effective. Patients with chronic SIADH may be treated with demeclocycline; however, this is not indicated in acute treatment. Students should identify that slow repletion of sodium is necessary to prevent the osmotic demyelination syndrome. Changes in neurologic function should be assessed frequently during the recovery period.
1. What subjective and objective information indicates the presence of SIADH?
2. Assess the severity of SIADH based on the subjective and objective information available.
3. Create a list of the patient's drug therapy problems and prioritize them. Include assessment of medication appropriateness, effectiveness, safety, and patient adherence.
4. What are the goals of pharmacotherapy in this case?
5. What nondrug therapies might be useful for this patient?
6. What feasible pharmacotherapeutic alternatives are available for treating SIADH?
7. Create an individualized, patient-centered, team-based care plan to optimize medication therapy for this patient's SIADH and other drug therapy problems. Include specific drugs, dosage forms, doses, schedules, and durations of therapy.
8. What information should be provided to the patient to enhance compliance, ensure successful therapy, and minimize adverse effects?
9. Describe how care should be coordinated with other healthcare providers.