MORTALITY

75/malay/gentleman
Was admitted in orthopaedic ward since 1/5/13
Was referred to medical on 4/5/13 for hypernatraemia

He has no past medical history
Alledged MVA on 25/4/13 (D9)and was sustained closed fracture neck of Rt.
Humerus and was put on u-slab.

He was presented again in casualty on 30/4/13 with reduce conscious
associated with redness and swelling over right arm


Was treated as sepsis secondary to Rt arm cellulitis with AKI
secondary to dehydration
Currently on D2 iv tazocin 4.5g tds
Renal function was improving with hydration
But noted sodium increasing intrend up to 161

Clinically patient tachypnea with a lot of secretion
Bp-112/43
Pr-88
Cvs-s1s2 no murmur
Lung-transmitted sound
I/O -4200/1680-+2520
U/O -70 cc perhour
patient was on 6 pint NS/24hr then 8 pint HS/24

DATE/
RP
24/4 30/4 1/5 2/5 3/5 4/5 5/5 6/5 7/5 8/5
CREAT 86 236 131 83 78 75 76 69 70 104
UREA 5 34 21.2 12.9 11.3 10.7 10.8 10.1 11.1 13.5
NA 144 151 152 155 162 161 157 156 156 156
K 3.9 3.8 3.6 3.4 3.2 3.4 2.8 3.2 3.4 3.5
CL 108 116 125 127 131 131 127 123 124 127
Plan
Change ivd to 4 pint D5/24hr
Monitor RP
suggest to insert ryles tube and to start feeding
Suggest for regular suction and chest physio
Suggest for ct-brain if GCS remain poor
CT-brain was done on 5/5/13
Showed lacunar infarct at the left external capsule
informed to medical regarding ct-brain finding
Started on t.aspirin 150mg od and t.simvastatin 20mg ON