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4th March 2024
An 85-year-old male has presented to the emergency department with a seizure.
An 85-year-old male has presented to the emergency department with a seizure. He is witnessed to have a tonic-clonic seizure in the emergency department. He is given 4mg IV lorazepam which terminates the seizure.
His wife tells you that he had been feeling generally unwell for the last day. He had been complaining of headaches, low energy and muscle cramps. He has a past medical history of depression and takes 200mg sertraline OD and omeprazole 20mg OD. He also drinks 4-5 cans of beer every day.
A CT head is requested.
CT Head Report: Nil acute abnormality detected.
You request some blood tests:
| Blood Results | Reference Ranges | |
| Na | 112 | 135-145 mmol/L |
| K | 4.3 | 3.5-5 mmol/L |
| Creatinine | 72 | 70-150 μmol/L |
| Urea | 9 | 2.5-6.7 mmol/L |
| eGFR | 83 | >90 mL/min/1.73m2 |
He is admitted to the ITU and treated with 150 mls hypertonic (3%) saline over 20 minutes.
Bloods taken 24 hours later show:
| Blood Results | Reference Ranges | |
| Na | 124 | 135-145 mmol/L |
| K | 3.6 | 3.5-5 mmol/L |
| Creatinine | 63 | 70-150 μmol/L |
| Urea | 7.8 | 2.5-6.7 mmol/L |
| eGFR | 85 | >90 mL/min/1.73m2 |
He has had no further seizures during admission.
Select the most appropriate further management:
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