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Suggest Treatment For Osteoarthritis And Electrolyte Imbalance

Posted on Sat, 9 May 2015

Question: Dear Dr. XXXXXXX

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

In case if you require any reports please let me know.

Hence I request you to provide me a way out, then I would be obliged.

Awaiting for a quick reply.

Thanks & Regards,
XXXX

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer:
Sodium needs to be corrected.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your father's medical details, current problems and list of medications.

There are three issues to be tackled:

1. Sodium level is low (126). Low sodium is known to cause behavioural changes, hallucinations, confusion, etc. This should be corrected to a level of 135 or more.

2. Urine infection/urosepsis- In older people, any infection especially urosepsis, is known to cause confusion and disorientation. Proper treatment of infection would lead to improvement in mental/brain condition over the next 7-10 days.

3. Multiple clots in brain- As per MRI, there are multiple areas of blood clots (infarcts) due to less blood flow. This leads to a type of dementia called as vascular dementia. Dementia can also contribute to behavioural changes. This would require assessment by a neurologist as well as a neuropsychologist after 1-2 weeks, when his sodium is corrected and urine infection is treated.

In the meanwhile, he can be given quetiapine tablets to reduce confusion and hallucinations.

I hope it helps.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (14 hours later)

Dear Sir,

Could you please suggest me the steps to be followed for the treatment for the above problem.
1st one you suggested to take quetiapine tablets.(If you could specify the frequency) similarly if you could suggest the next steps.

Please let me know if you require any other reports.

So that we can follow for his recovery.

Thanks & regards,
XXXX

Answered by Dr. Sudhir Kumar (3 hours later)

Brief Answer:
Steps are mentioned below.

Detailed Answer:
Thank you for getting back.

1. Sodium correction can be done either by giving saline infusion as drip or by adding extra salt in the diet. This can be done under the guidance of general physician.

2. Urine infection also can be treated by general physician.

3. Quetiapine is generally started at a dose of 25 mg half tablet at night. Depending on the response, the dose can be increased to 25-50 mg once daily at nights.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar