What Does The Following Medical Reports Suggest?

Posted on Sat, 18 Apr 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 18 Apr 2015 Answered on

Sat, 9 May 2015 Last reviewed on

Question : Dear Doctor,

I am writing to you on behalf of my Father, who is 68 years old & with following medical history stays near XXXXXXX

Medical History:
1. Right side paralysis in the year 2011
2. Prostomegaly since 7 years
3. Osteoarthritis since 2000.
4. Admitted in hospital in the year 2013 for electrolyte imbalance & Acute kidney failure.
5. Recently admitted for Urosepsis(20 days back)
6. Dry eyes

Now he is talking in different way. I mean his hallucination is increasing & always in anger mood.Even though all the parameters are normal.

Medication:
1. Minipress XL
2.Cardivas CR
3. Stamlo 2.5
4. Wysolone
5. Folic acid
6. Clopidogrel
7.Folitrax 7.5 mg but stopped since 20 days
8. Stegeron since 4 days
9. Rejunex CD3
10. Rivotril stopped since 20 days

Eye medication:
1. Restasis
2. Lacrigel
3. systane ultra
4. Gentel gel

I would be grateful to if you can provide me some solution for the same, then I would be obliged.

Desperately awaiting for a quick reply.

Thanks & Regards,
XXXX

Answered by Dr. Prasanna Heijebu (38 minutes later)

Brief Answer:
Possible Metabolic encephalopathy?Get a complete metabolic screen.

Detailed Answer:
Hi XXXXXXX

I understand your concern.

I have gone in detail through all the reports.

The hallucinations and mood changes should point to underlying electrolyte abnormality primarily in the setting of renal failure 2013 and recent onset of urosepsis.

Likewise the sudden withdrawal of Rivotril also precipitate changes in mood and hallucinations in the elderly.But these changes are short lived in presence of usage of drugs like Stegeron.

Hence its extremely important that a complete Metabolic screen should be performed at the earliest.

This includes Serum electrolytes,blood urea ,serum creatinine and complete urine examination.

Urosepsis has to be treated efficiently in the elderly.

This requires prompt re-evaluation of urosepis managed at the time of admission.

Coming to Progressive supranuclear palsy,mentioned as a possibility in the scan,it should be thought of only after ruling out Metabolic encephalopathy.

Post your further queries if any.
Thank you.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Prasanna Heijebu (15 hours later)

Dear Doctor,

Could you please suggest me the steps to be followed for the treatment for the above problem.

Please let me know if you require any other reports.

So that we can follow for his complete recovery.

Thanks & regards,
XXXX

Answered by Dr. Prasanna Heijebu (10 hours later)

Brief Answer:
Please provide test results.

Detailed Answer:
Hi Mam.

As said earlier,he needs following basic tests initially.

Serum electrolytes,blood urea ,serum creatinine and complete urine examination.

I would like to guide you further if you provide me with the results of these tests at the earliest.

Thank you.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj