Professional Documents
Culture Documents
Case
93 ♂
PC
4/7 Confusion, agitation + general
deterioration
3/7 poor urine output
PMH
BPH
Long term catheter in situ
MI
DH
Omeprazole 20mg po od
Betahistine 8mg po om
Aspirin 75mg po om
Calcichew D3 forte
SH
Temp 35.8
Dehydrated
GCS 13/15
AMTS 7/10
Urine
offensive odour
Dip +ve blood, leukocytes, nitrites
Bloods
WCC 14.1
Neut 9.7
Hb 12.0
Na 126
K 4.4
Urea 3.8
Creat 78
CRP 10
Diagnosis
Acute confusion
UTI
Hyponatraemia
Ciprofloxacin 5/7
Omeprazole + betahistine stopped
Day 2
GCS 7/15
CT Brain
Small vessel ischaemia
No evidence of space occupying lesion,
intracranial haemorrhage or skull #
CRP 46
After 2/52
GCS 15
AMTS 10/10
A/W discharge home
Prophylactic trimethoprim
Delirium
Benzodiazepines
Lorazepam 0.5-1mg tds orally
Shorter half life than diazepam +
effective at lower doses
S/E - Respiratory depression,
increased risk of falls, hypotension
Not for long term use
Medications
Antipsychotics
Avoid in PD
Haloperidol 0.5-1mg
S/E – cardiac, avoid in patients with
hypotension, tachycardia + arrhythmias,
extrapyramidal
Recent evidence suggests not to use in
patients with dementia or risk of CVD due to
increased risk of cerebral ischaemia
3X increase in risk of stroke when Risperidone
used in older patients with dementia
Medications
Malnutrition
Aspiration pneumonia
Pressure ulcers
Weakness, decreased mobility,
decreased function
Falls, #s
Outpatient Care