latest obs 4m ago

Patient intelligence · showcase: minor-sodium-decline

M. Haddad · 59F

Bed 02 · CHF · hospital day 5 · Decompensated heart failure, diuresing well; weight falling as planned.

Context: IV furosemide 40 mg bd · Bisoprolol, ramipril

VYZR Care RPP Engineconnecting…

Minor · Stable

Sodium 134 → 133 → 132 mmol/L over 47h — a small drift at the edge of assay noise (−1 mmol/L on the last sample). Noted, not escalated: no meaningful rate, no persistence beyond noise. If the current slope continues: Na⁺ ≈ 131 (130–132 mmol/L) at 24h.

Preparing narrative…

01 · Recognized · last 3 d

Minor · Stable

Minor sodium drift

Sodium 134 → 133 → 132 mmol/L over 47h — a small drift at the edge of assay noise (−1 mmol/L on the last sample). Noted, not escalated: no meaningful rate, no persistence beyond noise.

Pattern strength0/100 · limited evidence

Experimental explainable index, not a probability. No supporting signal measured 0 measurements across supporting signals

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Measured · 3 points · last 1h agoProjected · shaded = uncertainty band

132 mmol/L (−1 mmol/L since previous), below range, stable · 2 consecutive falls.

Sodium

132 mmol/L · stable · 2 consecutive falls

Consciousness (0 = alert, 1 = new confusion / CVPU)

0 · stable

02 · Predicted

24hlimited evidence confidence

If the current slope continues: Na⁺ ≈ 131 (130–132 mmol/L) at 24h.

Next in line if this continues: None expected at this rate; a further fall of ≥3 mmol/L on the next sample would change the picture.

Limited evidence — few measurements or key inputs missing. Bands are wide and a single new value can change this picture.

Projections · 1 made · 0 withheld

Sodiumols-recent · fitted on 3 points · slope -0.04 mmol/L/h

+6h · Sep 25 21:41

132 (131–133)

+12h · Sep 26 03:41

131 (130–133)

+24h · Sep 26 15:41

131 (130–132)

Alternative explanations

· Haemodilution from intravenous fluid load rather than a new sodium-handling problem.
· Sampling or laboratory variation — a single repeat value would confirm or refute.
· Recent diuretic effect (documented in medication context).
· Pseudohyponatremia with marked hyperglycaemia or hyperlipidaemia.

04 · Consider now

No change to routine monitoring suggested; the next scheduled sodium will confirm whether this is drift or noise.

Not judged to justify an interruptive alert — surfaced for review at the next natural checkpoint.

Would sharpen the picture: Glucose not available (needed to exclude translocational hyponatremia) · Serum and urine osmolality not in record · Fluid balance chart not in record

Decision support only · no order has been placed · engine rpp-0.4.0 · no recent data

03 · Connected

What may be causing what

Mechanistic chain assembled from the recognised features. Each link is a hypothesis for bedside verification, not an established cause.

Falling serum sodiumosmotic water shift into brain cellsCerebral oedema → confusion, seizure risk

Rate of fallless time for cerebral adaptationSymptoms at higher absolute sodium than in chronic cases

Evidence · 6 raw observations

Timestamps are real and irregular · click an observation to focus its trace above

04 · Prevention prompts

Consider, investigate, monitor, escalate

Clinician-support prompts derived from the pattern — not prescriptions. Status is persisted so the team sees what has been planned or judged not appropriate.

Monitor

No change to routine monitoring suggested; the next scheduled sodium will confirm whether this is drift or noise.

Changed since last review · 1 meaningful

Systolic blood pressure · 121 mmHg → 115 mmHg (−6 mmHg, 8 min ago)falling

Respiratory rate · 17 /min → 18 /min (+1 /min, 4h ago)flat

Oxygen saturation · 96 % → 96 % (±0 %, 4h ago)flat

Heart rate · 73 /min → 73 /min (±0 /min, 17 min ago)flat

Temperature · 36.7 °C → 36.8 °C (+0.1 °C, 4h ago)flat

Consciousness (0 = alert, 1 = new confusion / CVPU) · 0 → 0 (±0, 4 min ago)flat

Urine output · 107 mL/h → 108 mL/h (+1 mL/h, 8 min ago)flat

Sodium · 133 mmol/L → 132 mmol/L (−1 mmol/L, 1h ago)flat

Reassuring signals · 4

Oxygen saturation · 96 % — in range and steady.

Systolic blood pressure · 115 mmHg — in range and steady.

Heart rate · 73 /min — in range and steady.

Temperature · 36.8 °C — in range and steady.

Synthetic demonstration · engine output requires clinical correlation and is not a diagnosis