Confusion and Severe Hyponatraemia in a Man with Small Cell Lung Cancer
A branching clinical case simulation for a patient presenting with progressive confusion, serum sodium 118 mmol/l. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min6 stages
- Patient
- 68 years, male
- Presenting complaint
- Progressive confusion, serum sodium 118 mmol/L
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
You are the senior house officer on the acute medical unit at a district general hospital. A 68-year-old man with known small cell lung cancer is brought in with a 3-day history of increasing confusion. His serum sodium is 118 mmol/L. The registrar asks you to assess him and manage his hyponatraemia. This is a teaching case, not a real patient. Make your decisions carefully.
What this case teaches
Classify hyponatraemia by volume status and serum/urine osmolalities; recognise SIADH; correct sodium at a safe rate and know the danger of overcorrection; treat seizures with hypertonic saline.
How the case unfolds
- 1Focused HistoryHistory
- 2Physical ExaminationExamination
- 3InvestigationsInvestigations
- 4DiagnosisDiagnosis
- 5ManagementTreatment
- 6Monitoring and Further CareMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
Log in to run "Confusion and Severe Hyponatraemia in a Man with Small Cell Lung Cancer"
A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
More like this
- Prescribing case: Addisonian Crisis in a Patient with Vomiting and Fever
- Giant Cell Arteritis with Visual Symptoms: An Emergency
- Hypercalcaemia in Breast Cancer: A 66-Year-Old Woman
- Prescribing case: Newly Diagnosed Type 2 Diabetes: Initiating First-line Therapy
- Crushing Chest Pain: An Anterior ST-Elevation Myocardial Infarction in a 58-Year-Old Man
- Dehydration in a 2-year-old with vomiting and diarrhoea
Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.