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+--- Thread: q_____________? - sarim (/showthread.php?tid=675901)
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q_____________? - sarim - ArchivalUser - 05-07-2012
A 23 y/o gravida 2, para 1 female was admitted in the delivery room at 38 wk gestation for the management of labor.After one day of hospitalization she delivered a 7.5 lb healthy baby.Her prenatal course was normal except for mild gestational diabetes which was under control with diet and insulin.Her medical hx is unremarkable.After the delivery the pt developed 2 episodes of generalized tonic-clonic convulsions.physical exam is unremarkable.Urinalysis reveal concentrated urine and proteinuria of 1+.
Serum electrolytes are
Na+------ 123 mEq/L
K -------- 3.5 mEq/L
Cl ------- 99 mEq/L
Vitals;
Temp ------- 98.7F
BP ---------- 128/82
RR---------- 18/m
PR---------- 78/m
During delivery she received regular insulin and IV oxytocin.What is the most likely Dx in this pt?
A-Postpartum eclampsia
B-Water intoxication
C-Glomerulonephritis
D-Preeclampsia
E-Idiopathic epilepsy
0 - ArchivalUser - 05-07-2012
with 1+ proteinuria and a decrease sodium + 2 convulsions...
the diagnosis should be postpartum eclampsia but the primary cause would be preclampsia... which lead to eclampsia..
so DDD ??
0 - ArchivalUser - 05-07-2012
Blood Pressure ?
Convulsions in preeclampsia ?
0 - ArchivalUser - 05-07-2012
oh yah blood pressure is normal!!!!
no convulsions post preeclampsia right ? ... cause to have eclampsia you must prior have preeclampsia... but this patient has normal blood pressure.... read it but completely forgot!!
Ill change my answer to AA... not idiopathic epilepsy because there wouldn't be a need for increase protein ??
hopefully im right this time
0 - ArchivalUser - 05-07-2012
again this pt got "Normal B.P." and -physical exam is unremarkable(means no edema)---- so rule out eclampsia.
0 - ArchivalUser - 05-07-2012
pt :
2 tonic clonic convulsions
+1 proteinuria
normal BP
slightly decrease sodium the rest are normal....
and its not preclampsia and eclampsia as corrected ....
3rd time is a charm : BB .... but i dont think this causes convulsions...
0 - ArchivalUser - 05-07-2012
B is correct.
Try figure it out with
-Urinalysis
-Serum Na levels
-Last line of the Q
0 - ArchivalUser - 05-07-2012
BB...........hyponatremia, conc urine, seizures
0 - ArchivalUser - 05-07-2012
darn!!! i gotta work on my path its weak!!
inshAllah soon
thank you @sarim godbless
I appreciate the step by step and not given away the answer rather lettin me work it up thank you so much!
0 - ArchivalUser - 05-07-2012
Excessive use of "OXYTOCIN" may cz water retention as it has antidiuretic effect because of it's similarity in structure with ADH.