Pediatrics -> Geriatrics

Now in my final unit of the academic year, I finally finish with the geriatrics block (big change from the pediatrics as I was about to find!). Although just 2 weeks into it, I am beginning to think that geriatrics is not as intriguing as I had hoped. When I worked as a volunteer, I loved chatting with the elderly. You had all the time in the world to speak to them.

But now as a medical student, it becomes a bit different. Your role is to gather a history, give some differential diagnosis, leaving you little time for a chat (if you want to get your work done)

I liked interacting with pediatric patients more... or maybe I just think too much about the few not-so-good experiences with dementia/delirious patients I met. However I think the pathology/diseases that present in the geriatrics ward are more interesting than the pedatric ones. There were tons more murmurs to hear (predominantly MR). It has also given me more opportunity to look out for abnormalities therefore systems examination become more relevant.

A patient with lung CA (maybe small cell?) had paraneoplastic syndrome. One of it being SIADH.
The syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) is characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia and sometimes fluid overload. It is usually found in patients diagnosed with pneumonia, brain tumors, head trauma, strokes, meningitis, encephalitis, or small-cell carcinoma of the lung.

Suspect SIADH if all of the following diagnostic criteria are met:

• Hyponatraemia (serum sodium concentration less than 135 mmol/L).
• Decreased plasma osmolality (less than 280 mOsmol/kg).
• Increased urine osmolality (greater than 100 mOsmol/kg).
• Increased urinary sodium concentration (greater than 30mmol/L).
• No clinical or biochemical features of adrenal and thyroid dysfunction.
• No dehydration on clinical examination.
• No use or recent use of diuretic medication.

• Most people with hyponatraemia are asymptomatic, particularly if hyponatraemia is mild (serum sodium concentration of 130–135 mmol/L) and has developed slowly.
• When symptoms of hyponatraemia are present, they are often non-specific and are related to both the severity of the hyponatraemia and its rate of onset.
• Early symptoms
• Anorexia.
• Nausea.
• Lethargy and apathy (associated with slow-onset hyponatraemia).
• Late symptoms (associated with severe or rapid-onset hyponatraemia).
• Disorientation.
• Agitation.
• Seizures.
• Coma.

Treatment: Fluid restriction, hypertonic saline, demeclocycline (to induce DI)

With saline infusion: A rapid rise in the sodium level may cause central pontine myelinolysis.^[6] Avoid correction by more than 12 mEq/L/day

I hope to spend more time on this unit examining patients!

Source: Wikipedia and CKS NICE