88F altered sensorium secondary to hyponatremia

 A  88 yrs old  Female  presented to casualty with

C/o  irrelevant talk and altered mental status since 10 days
Shortness of Breath since 3 days 
Cough since 3 days 

HISTORY OF PRESENT ILLNESS:
Patient was  asymptomatic 10 days ago and then developed altered mental status on & off and her speech being non cohorent  at times and later becoming normal by herself , each episode  lasting for 10- 15 mins .
Productive cough 2 days ago 
Now dry cough
Shortness of breath since  3 days  initially grade III
progressed  grade IV in these  3 days. 
Later went to outside hospital and 2 D echo was done  
2 D echo ( CAD , LAD + territor) , Global Hypokinesia , Severe LV dysfunction 
No history of chest pain , palpitations , giddiness.

HISTORY OF PAST ILLNESS:

N/ K/C/O HTN , DM , CVA , Epilepsy , Asthma 

PERSONAL HISTORY: 
DIET: MIXED 
APPETITE: DECREASED 
BOWEL AND BLADDER MOVEMENTS: REGULAR 
SLEEP: ADEQUATE 
ADDICTIONS: NO

ON EXAMINATION :

PATIENT IS CONSCIOUS NON COHERENT AND COOPERATIVE 
PATIENT IS CONSCIOUS NON COHERENT AND COOPERATIVE 

GENERAL EXAMINATION:
NO PALLOR ICTERUS CYANOSIS CLUBBING LYMPHADENOPATHY EDEMA 

VITALS:
BP- 90/50 MMHG
PR- 85BPM
RR- 24CPM
SPO2- 88% @RA , 94% on HIGH FLOW O2
GRBS- 126MG/DL

CVS- S1 S2 HEARD. NO MURMURS 

RS -Barrel shaped chest , BAE + 
        Crepts + , Left IAA ,ISA
       Bronchial  breath sounds , 
        

Right ISA

PA - soft , nontender
TEMP - AFEBRILE 
CNS : Not oriented to T /P/P
           NFD

Urinary Electrolytes:
Chloride - 94
Potassium - 30
Sodium - 127

GAIT - NORMAL 
GCS- E4V5M6



PROVISIONAL DIAGNOSIS:
HEART FAILURE WITH REDUCED EJECTION FRACTION SECONDARY TO CAD ?
WITH ANT. WALL MI ?
WITH TRUE HYPONATREMIA 
AND WITH RIGHT MILD PLEURAL EFFUSION ?

INVESTIGATIONS:
ON 3/04/2023
ECG :


Arterial blood gas :

Chest X -RAY :

 Blood UREA :


SERUM ELECTROLYTEs :



TROP I :



HEMOGRAM:




CHEST X RAY  LATERAL VIEW :






2D ECHO REPORT 




INVESTIGATIONS:




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