Today, Dr. Poi asked:

" So youjiang, why must we correct sodium levels at around 8-10mmol/L a day?"

So i replied:

"i dunno. like seriously i dunno."

I looked at the House Officer.

He looked at me. I knew we made a connection when he gave me the "oh shit look away i dont know either" look.

Ladies and gents, the correct answer is:

CENTRAL PONTINE MYELINOLYSIS!

this is classically observed in alcoholics

alcoholics often have hyponatremia

overvigorous correction results in CPM

note: damage to myelin sheath happening in pons and beyond = ODS osmotic demyelination syndrome

Cranial nerve lesions with quadraparesis

(acute paralysis, dysarthria, dysphagia)

KIV locked in syndrome (ventral pontine syndrome)

urine dipstick: nitroprusside coated, changes color with acetoacetate

Capillary blood for betahydroxybutyric acid

chorea = caudate
athetosis = putamen
hemiballismus = basal ganglia

Polymyalgia rheumatica

- it means pain and stiffness in many muscles (neck shoulders hips especially)

- due to an inflammatory condition of the muscles

- onset can be both acute and insiduous

- WBC attacking joint lining

Typical history:

- usually in adults > 50 yo, women 2x > men

- acute/insiduous

- pain in their muscles on waking, so muhc so that activity is limited

- fatigue and LOA

- anemia

- general sense of being unwell

Look out for signs and symptoms of temporal arteritis: 50% have temporal arteritis

- fever headache

- jaw claudication

- tongue claudication

- reduced visual auity or acute visual loss

Investigations:

For polymyalgia rheumatica: no specific ones:

- FBC

- ESR and CRP are raised

For temporal arteritis:

- FBC: raised platelets

- ESR and CRP are raised

Gold standard for diagnosing temporal arteritis is biopsy of temporal artery from multiple parts

Imaging studise: US shows halo sign, others include MRI and CT

Treatment:

Pain relief and prevention of weakening of muscles:

- Exercise

- Mild pain: aspirin, ibuprofen

- Severe pain: steroids (prednisolone)