Physician's Assistant

Patient Details

Sdec (44 days ago 16:28)

Sdec Sat 21 February 2026 16:28

Last Modified: 44 days ago

MRN:

Content:

Presenting Complaint:
Feeling unwell, hypotension and bradycardia

Past Medical History
• Atrial fibrillation - on anticoagulation
• Depression
• Recent bereavement (brother died in last two weeks)
• Previous investigation for weight loss (August-September 2025) - normal faecal elastase, normal FIT test, normal TTG

Diagnosis:
Hypotension and bradycardia secondary to reduced oral intake in context of low mood and recent bereavement. Investigations reassuring with no organic cause identified.

I had the pleasure of meeting Mr Jelfs in Same Day Emergency Care today.

Mr Jelfs is a 71-year-old gentleman weighing 53kg who presented feeling generally unwell with concerns about hypotension. He has a background of atrial fibrillation for which he is anticoagulated, and depression. Significantly, he lost his brother in the last two weeks and has been struggling with low mood since then. He reports poor self-care with reduced oral intake, relying on friends to feed him. His last meal was rice yesterday evening, and today he has only had water and tea. He denies fevers, cough, cold, or dysuria.

On examination, he appeared thin and cachectic. His heart rate was 53 beats per minute. Heart sounds were normal, chest was clear, and there was no peripheral oedema. Abdomen was soft and non-tender but he appeared thin and cachectic. Blood pressure was consistently normal during his stay.

Investigations:
TSH: normal
Bone profile: normal
Renal function: normal
LFTs: normal
CRP: 5
Urea: normal
Full blood count: normal, no anaemia
Venous blood gas: normal, pH 7.4
Previous investigations (August-September 2025): Faecal elastase normal, FIT test normal, TTG normal

Plan:
1. All blood tests including thyroid function are reassuringly normal
2. Blood pressure remained stable throughout stay in SDEC
3. Patient mobilised well with no postural symptoms
4. Discussed importance of maintaining adequate oral intake
5. Encouraged to continue engagement with friends for support
6. Consider review by GP regarding depression management in context of recent bereavement
7. Patient discharged home with transport arrangements made
8. Advised to return if symptoms worsen or new concerns develop

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Patient Details

Sdec Sat 21 February 2026 16:28

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