Psychiatric patient with h/o lung Ca

Chief Complaint A 67 y/o male came with disorientation, mental confusion & restlessness. History He is a smoker, smokes 10-12 cigarettes/ day. She has psychiatric history & h/o small cell lung Ca with a metastasis to the right parietal cerebral lobe and had treatment with chemotherapy and radiotherapy. On medicine: Desametason & Pantoprazole Vitals BP 135/80 mm Hg, HR: 95 bpm, Resp rate: 25 breaths per minute, and oxygen saturation of 93%. Examination On examination patient was confused, disoriented and irritable. He was fully consciousness. Thoughts were disorganized with paranoid delusions. He said he has insomnia also. Investigations HB: 11.5 g/dl and HCT 37.0%, All other reports are normal. Treatment What should be the treatment approach?

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? METASTATIC ..COMPLICATIONS.. NEED'S.. FURTHER EVALUATION WITH.. EXPERTS OPINION.. ? CEREBRAL ATROPHIC.. DEGENERATIVE CHANGES..WITH..ASSOCIATED COMPLICATIONS..

Tnx Dr Sandeep Ghodekar sir
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Needs further investigation and evaluation to conclude particularly PET Scan to know the extent of degenrative changes and cerebral atrophy .

Thanks Dr Sandeep Ghodekar
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May be excerbation cerebral metastasis responsible for irrelevant behaviour Adv fresh MRI brain

Thanx dr Girish Sanghavi
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Needs investigations Secondaries in brain , brain edema, Hypo natremia , all can cause disorientation PETCT suggested

Go for PET scan. Further management accordingly.

SINCE H/ O... CARCINOMA. LUNG ADVISABLE RULE. OUT METASTASES NEEDS. FURTHER. EVALUATION

Delirium

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