Fluid and electrolyte imbalances

A 74-year-old man is on day 2 after an emergency Hartmann procedure for perforated diverticulitis. He takes spironolactone and perindopril for heart failure. He…

Pre-internship · common

A 68-year-old woman with recently diagnosed small cell lung cancer is brought in after a generalised tonic-clonic seizure at home. Over three days she has becom…

Pre-internship · middle twist

An 18-month-old girl weighing 10.0 kg has had four days of diarrhoea and has been given water and diluted cordial at home. She is lethargic with a doughy feel t…

Pre-internship · niche

A 4-year-old girl is admitted with four days of diarrhoea. She is 10 per cent dehydrated but not shocked, and her serum sodium on arrival is 172 mmol/L (135-145…

Pre-internship · middle twist

A 3-year-old boy is seen in general practice with a two-day blanching viral rash and is otherwise well. He is eating, playing and having his usual number of wet…

Pre-internship · niche

An 8-year-old girl with chronic kidney disease is brought in vomiting after missing two dialysis sessions. She is alert and her blood pressure is 128/78 mmHg. S…

Pre-internship · common

A 5-year-old boy weighing 20 kg is admitted with bacterial meningitis. He is alert, his peripheries are warm with capillary refill under two seconds, and his mu…

Clinical rotations · middle twist

A 9-year-old girl is on day three of treatment for pneumococcal meningitis and has been receiving intravenous sodium chloride 0.9% with glucose 5% at full maint…

Pre-internship · niche

A 77-year-old woman is brought to the emergency department by her daughter because she has become confused and unsteady over three days. Five weeks ago her gene…

Clinical rotations · middle twist

An 84-year-old woman with metastatic breast cancer is admitted from her retirement village because over four days she has become drowsy by day, restless at nigh…

Clinical rotations · middle twist

A 62-year-old woman attends the emergency department after tripping on a step. She has a grazed knee, is otherwise well, takes only atorvastatin and passes urin…

Pre-internship · middle twist

A 76-year-old man taking ramipril and spironolactone attends with three days of vomiting and increasing lethargy. He is drowsy but rousable. Pulse is 42/min and…

Pre-internship · common

A 34-year-old man is seen in the medical tent 20 minutes after finishing a marathon run on a cool, overcast morning. He drank water at every drink station. He h…

Foundations · common

A 63-year-old man with metastatic squamous cell carcinoma has persistent thirst, vomiting and confusion. After intravenous saline, his serum calcium concentrati…

Clinical rotations · middle twist

A 54-year-old woman is treated for symptomatic hyponatraemia that has probably been present for several days. Her initial serum sodium concentration was 108 mmo…

Clinical rotations · niche

A 68-year-old man with chronic kidney disease is admitted with pneumonia and has received intravenous fluids, calcium gluconate and insulin with glucose for a s…

Clinical rotations · middle twist

An 82-year-old woman becomes confused and unsteady over three days while being treated for depression and hypertension. She is euvolaemic, her serum sodium is 1…

Clinical rotations · common

A 62-year-old woman who takes sertraline for depression is brought to the emergency department after a witnessed generalised tonic-clonic seizure at home. She i…

Clinical rotations · common

A 47-year-old man with chronic kidney disease presents with palpitations and proximal muscle weakness. Serum potassium is 6.8 mmol/L, the sample is non-haemolys…

Clinical rotations · middle twist

A 70-year-old man with diabetic kidney disease takes ramipril and spironolactone. Routine testing shows potassium 6.4 mmol/L, confirmed on a non-haemolysed samp…

Clinical rotations · middle twist

A 46-year-old woman presents with a generalised tonic-clonic seizure. Serum sodium is 112 mmol/L, serum osmolality is 240 mOsm/kg and glucose is 5.2 mmol/L. She…

Clinical rotations · common

A 58-year-old man with chronic kidney disease presents with weakness. Serum potassium is 7.1 mmol/L, and the laboratory result has been confirmed on a repeat no…

Pre-internship · common

A 35-year-old man reports drinking approximately 6 L of water daily because of anxiety about dehydration. He is alert, euvolaemic and not taking diuretics or an…

Clinical rotations · common

A 72-year-old man with Alzheimer’s disease is brought to the emergency room by his daughter due to confusion and lethargy over the past few days. His daughter s…

Pre-internship · middle twist