Patient History: An 89-year-old woman was admitted to hospital with new-onset confusion. Her daughter had noticed that she had become increasingly forgetful over the past week and now was no longer orientated to time and place. Her medical history was significant for hypertension, for which she took bendroflumethiazide. She was normally independent in her activities.
Physical Examination: The patient’s urine dip was found to be normal and her inflammatory markers were not elevated. Laboratory Findings: Sodium- 114 (Normal range; 135–145 mmol/L) Potassium- 3.8 (3.5–5.0 mmol/L) Urea- 6.8 (3.0–7.0 mmol/L) Creatinine- 98 (60–110 umol/L) The patient was given 4 L of 0.9% saline over the next 24 hours. The following morning, she became more confused, drowsy and dysarthric. When a neurological examination was performed, she had reduced power throughout all muscle groups and there were increased…
