Dry as a bone, hoarse as a raven

91 year old man, living with his girl friend was brought it because he was weak and he stopped talking.

His family, three kids, all lived very far from him. They had essentially given up his care to his girlfriend of 10 years. According to her, everything had be going fine but a week before admission patient got very weak and eventually he stopped being able to talk. The inability to speak is what caused her to call 911.

Our work up was very short because we got the diagnosis quickly. His CT head was negative for a stroke but his blood tests revealed a sodium of 198! To the uninitiated, this is astounding - a normal is 135-145. Whenever, the value goes higher than that your "thirst center" kicks in and you drink water. Clearly, his hadn't done that. This prompted us to check an MRI of his brain, thus revealing a stroke in this hypothalamus.

But why couldn't he talk!?? We did a CT Neck which didn't real anything significant. We asked an otolaryngologist to evaluate him. That doctor did not find anything when he looked at the patients vocal cords with a camera. It was thus assumed to be vocal cord paralysis from the stroke.

We treated the patients hypernatremia and on the day his Sodium was normal he started to talk! It was insane, I said "I don't know if you can understand me but, we are planning on discharging you to a nursing home probably tomorrow." And he came back with: "thanks man, thank you so much for all your help!" I literally jumped and said "you can talk!" He shared how he hasn't talked because it hurt to talk! "Everything was so dry.". As we had fixed his hypernatremia, we had fixed his dehydration and he could talk again!

We were able to discharge him to a nursing home, fairly soon after that. Moral of the story: don't trust your 91 year old father's GIRLFRIEND to take care of him!