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Postcystoscopy confusion

Q1: What is the most likely cause for this patient’s acute confusional state?
The patient has an acute episode of confusional state on the first postoperative day with no clinical evidence of focal neurological deficit. Laboratory investigations revealed a sudden drop in serum sodium, which is the most probable aetiology for his acute confusional state.

Q2: What further investigations/calculations would help in your management?
For further management of this case, serum osmolarity and osmolar gap should be calculated. They can be approximately calculated from the following formulas:

In our case, the calculated osmolarity was 257.3 mmol/l and the osmolar gap was 6.7 mOsm/l (normal <10 mOsm/l). Other investigations like arterial blood gas analysis to evaluate the severity of the metabolic acidosis and serum ammonia levels should be done.

Q3: How would you manage this case?
Management should be tailored to the individual case depending upon the severity and relative duration of the onset of confusion, serum osmolarity, osmolar gap, serum ammonia levels, and renal function of the patient. In our case, as the hyponatraemia is severe (<120 mmol/l) and . . . [Full text of this article]

Relevant Article

Postcystoscopy confusion

S Kumar and S Uthamalingam
Postgrad. Med. J. 2004 80: 45. [Extract] [Full Text] [PDF]