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Postcystoscopy confusion
  1. S Kumar,
  2. S Uthamalingam
  1. Department of Medicine, Sound Shore Medical, Center of Westchester, New York Medical College, USA
  1. Correspondence to:
 Dr Shanmugam Uthamalingam
 Department of Medicine, Sound Shore Medical, Center of Westchester, New York Medical College, 16 Guion Place, New Rochelle, New York 10802, USA; uthamalingamhotmail.com

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Answers on p47.

A 78 year old man presented to the emergency room with a one day history of haematuria and lower abdominal pain. He denied having fever, dysuria, or dizziness. His past medical history was significant for carcinoma of prostate diagnosed 10 years ago. He had been treated with prostate seeding (brachytherapy) four years previously. He denied taking any other medications.

On examination he was alert, oriented in time, place and person, with a pulse 88 beats/min with regular rhythm, blood pressure 130/70 mm Hg, and temperature 37.4°C. Cardiorespiratory examination was within normal limits. Abdominal examination revealed a soft but tender hypogastrium with normal bowel sounds. There was no focal neurological deficit. A 20 size foley catheter was placed with drainage of approximately 350 ml of blood tinged urine.

An urgent urology consultation was obtained and cystoscopy was performed. The bladder was irrigated with 1.5% glycine solution during the perioperative period. On his first postoperative day, he was found to be drowsy, confused, and agitated. He was haemodynamically stable but disoriented in time, place, and person. There was no focal neurological deficit or signs of meningeal irritation. His abdominal examination remained unchanged. His laboratory results on the day of admission and the first postoperative day are shown in table 1. Urgent computed tomography of the brain was performed which did not reveal any intracranial bleed.

Table 1

Admission and first postoperative day laboratory findings (normal range in parentheses)

QUESTIONS

  1. What is the most likely cause for this patient’s acute confusional state?

  2. What further investigations/calculations would help in your management?

  3. How would you manage this case?

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