“Bit muddly and wobbly — it’s just my age, surely”

Sodium 121 mmol/L with NEW confusion, unsteadiness and a near-fall is symptomatic, significant hyponatraemia — a treatable, dangerous cause of exactly the symptoms too easily dismissed as "just getting old". The clinical skill is finding the stacked drivers: a recently started THIAZIDE (bendroflumethiazide is a classic, often early, cause of hyponatraemia in older women), an SSRI (citalopram → SIADH; its dose checked against the MHRA December 2011 limit of 20 mg over 65), a PPI (omeprazole, also a listed cause — BNF), and EXCESS hypotonic fluid (lots of squash from misapplied "stay hydrated" advice) compounding it. Hold the thiazide, review the SSRI, normalise the fluid intake, and arrange same-day hospital assessment and a repeat sodium — with awareness that symptomatic hyponatraemia at this level needs acute assessment (Society for Endocrinology guidance), severe symptoms (seizures, marked confusion, vomiting, reduced consciousness) are an emergency, and correction must be controlled (avoid over-rapid correction). The examinable hidden agenda is symptom-misattribution plus an independence/"a home" fear driving minimisation; treat the daughter’s concern as the reliable signal, reframe fixing the sodium as the way to STAY safe and independent, correct the over-drinking gently, plan a falls review, and safety-net the emergency features. Confusion, unsteadiness and falls in an older person are too easily written off as ageing; here they are symptoms of a treatable, dangerous electrolyte problem. Recognising the new symptoms as the sodium, not age, is the consultation.