A female with Altered Sensorium

female was admitted with altered sensorium, a history of vomiting and documented hyponatremia followed by fluctuating encephalopathy and a deep coma state. She was initially managed at a peripheral health center where her serum sodium was 98 mEq/L. She was treated for severe hyponatremia (duration of hyponatremia and rate of correction not known) with a slight improvement noticed by her family members initially. The patient was managed inititally at a primary health center by a primary care physician with slight improvement but soon developed fluctuating encephalopathy and was shifted to our medical center. On admission, the patient was still in a stuperous state with spontaneous guttural vocalization only and no active movement of her limbs. On examination, the patient had asymmetrical extra-pyramidal signs–more on the right side compared to the left. The patient had normal pupillary reflexes and maintained ocular movements. Spastic paralysis of all four limbs was associated with brisk deep tendon reflexes, hypertonia and the Babinski sign (the patient was in a locked-in like state with maintained ocular movements, normal pupillary reaction, brisk deep tendon reflexes and flexor responses to planters). The rest of the systemic examination was normal. Routine tests were normal except for serum sodium of 115 mEq/L and serum potassium of 1.98 mEq/L. The patient underwent magnetic resonance imaging (MRI) of the brain Acute pancreatitis Mild acute pancreatitis usually goes away in a few days with rest and treatment. If your pancreatitis is more severe, your treatment may also include: Surgery. Your doctor may recommend surgery to remove the gallbladder, called cholecystectomy, if gallstones cause your pancreatitis. Having surgery within a few days after you are admitted to the hospital lowers the chance of complications. If you have severe pancreatitis, your doctor may advise delaying surgery to first treat complications. Procedures. Your doctor or specialist will drain fluid in your abdomen if you have an abscess or infected pseudocyst NIH external link, or a large pseudocyst causing pain or bleeding. You may remove damaged tissue from your pancreas.

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