latest obs 12m ago

Patient intelligence · showcase: progressive-sodium-decline

L. Marchetti · 64F

Bed 09 · pneumonia · hospital day 6 · Community-acquired pneumonia, improving chest signs; new confusion overnight per nursing.

Context: Co-amoxiclav + clarithromycin · Regular sertraline (SSRI)

VYZR Care RPP Engineconnecting…

Concerning · Rapidly worsening

Sodium 138 → 133 → 127 mmol/L over 47h (−11 mmol/L) at ≈ −6 mmol/L per 24h, falling on 3 consecutive samples. The concern is the rate and persistence of the fall, not one low value. If the current slope continues: Na⁺ ≈ 124 (123–125 mmol/L) at 12h, crossing severe hyponatremia (<125) in ~8h.

Preparing narrative…

01 · Recognized · last 3 d

Concerning · Rapidly worsening

Progressive sodium decline

Sodium 138 → 133 → 127 mmol/L over 47h (−11 mmol/L) at ≈ −6 mmol/L per 24h, falling on 3 consecutive samples. The concern is the rate and persistence of the fall, not one low value.

Pattern strength68/100 · moderate evidence

Experimental explainable index, not a probability. 1 of 2 expected signals available 4 measurements across supporting signals

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Measured · 4 points · last 1h agoProjected · shaded = uncertainty band

127 mmol/L (−6 mmol/L since previous), below range, falling · −6 mmol/L/24h · 3 consecutive falls.

Sodium

127 mmol/L · falling · −6 mmol/L/24h · 3 consecutive falls

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

0 · stable

02 · Predicted

12hmoderate evidence confidence

If the current slope continues: Na⁺ ≈ 124 (123–125 mmol/L) at 12h, crossing severe hyponatremia (<125) in ~8h.

Next in line if this continues: Symptomatic hyponatremia — new confusion, nausea, headache, or seizure risk if the fall continues or accelerates.

Moderate evidence. Linear extrapolation of recent slope; interventions or a new measurement will change the projection.

Projections · 1 made · 0 withheld

Sodiumols-recent · fitted on 3 points · slope -0.23 mmol/L/h

+6h · Sep 25 21:39

125 (124–126)

+12h · Sep 26 03:39

124 (123–125)

+24h · Sep 26 15:39

121 (120–122)

severe hyponatremia (<125) in ~8h if the current slope continues (at Sep 25 23:39).

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.
· Pseudohyponatremia with marked hyperglycaemia or hyperlipidaemia.

04 · Consider now

Consider volume status, hypotonic fluid intake, SIADH triggers (pain, nausea, medications), diuretics, and adrenal/thyroid causes.

The engine judges this pattern strong, fresh and fast enough to justify interrupting a clinician.

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 · latest supporting value 1h ago

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.

Consider causes

Consider volume status, hypotonic fluid intake, SIADH triggers (pain, nausea, medications), diuretics, and adrenal/thyroid causes.

Missing information

Fluid balance and osmolality context would sharpen interpretation.

Investigate

Consider serum osmolality, urine sodium and osmolality, glucose, TSH and cortisol if the mechanism is unclear.

Monitor

Consider repeating sodium within 6–12 h rather than at the next routine draw, given the slope.

Medication review

Review thiazides, SSRIs, carbamazepine, PPIs and hypotonic maintenance fluids as contributors.

Level of care

Consider senior review if sodium falls below 125 mmol/L or any neurological change appears.

Changed since last review · 2 meaningful

Sodium · 133 mmol/L → 127 mmol/L (−6 mmol/L, 1h ago)falling

C-reactive protein · 120 mg/L → 60 mg/L (−60 mg/L, 1h ago)falling

Respiratory rate · 19 /min → 17 /min (−2 /min, 18 min ago)falling

Oxygen saturation · 95 % → 95 % (±0 %, 21 min ago)flat

Systolic blood pressure · 123 mmHg → 126 mmHg (+3 mmHg, 12 min ago)flat

Heart rate · 81 /min → 81 /min (±0 /min, 5h ago)flat

Temperature · 36.9 °C → 36.9 °C (±0.0 °C, 20 min ago)flat

Consciousness (0 = alert, 1 = new confusion / CVPU) · 0 → 0 (±0, 8h ago)flat

Reassuring signals · 5

Oxygen saturation · 95 % — in range and steady.

Systolic blood pressure · 126 mmHg — in range and steady.

Heart rate · 81 /min — in range and steady.

Temperature · 36.9 °C — in range and steady.

C-reactive protein · 60 mg/L — recovering toward range.

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