ben a presented a very interesting case of a young man in the UK for a course in political science as part of an Erasmus programme who presented to casualty with marked lightheadedness on standing of 1 days duration
we discussed (again) the issue of pinning down what a patient means by dizziness
here our patient was fine lying flat but became lightheaded with altered vision on standing
there was also associated nausea & abdominal pain
he was able to move into his flat (with the attendant box lugging) on the saturday
any ideas as to diagnosis?
_ _ _
there seems to be a clear story of postural symptoms, most likely secondary to hypovolaemia
[causes orthostatic hypotension?: diabetes, drugs, parkinsons, autonomic dysfunction, addisons]
we briefly talked about blood loss
(1 pint is actually a US pint or 473mL, not the UK (imperial) pint of 568mL)
catastrophic blood loss might occur into the gut, lungs, abdomen, pelvis
lethal bleeding (without exsanguinating) into the pericardium or brain
_ _ _
we mentioned the surface markings of the pleura but did not finish the conversation
see here for more
_ _ _
we then went to chat to our patient who has addisons disease
click here for thomas addison's own pictures (he was a physician at guys)
[NB why do people with addisons exhibit hyperpigmentation?]
JFK had addisons
our patient was first diagnosed in the US 2 months ago
he takes 20mg of hydrocortisone daily as his normal regimen (which he tripled over the weekend)
_ _ _
on examination he had no hyperpigmentation in the buccal mucosa or palmar creases
he had a 15mmHg systolic drop on admission (?now)
his abdomen was soft & non-tender with no masses or organomegaly
_ _ _
on arrival he had a Na of 120mmol/L with a K of 6.8
his ECG showed peaked T waves
he was given calcium gluconate & insulin/dextrose
_ _ _
we briefly mentioned causes of addisons disease:
autoimmune, infection (incl TB), hameorrhage, cancer, congential adrenal hyperplasia, pituitary problems
investigations:
importantly electrolytes, septic screen
_ _ _
things to read about:
1) addisons
2) emergency treatment of hyperK
3) hydrocortisone
Salaam
s
we discussed (again) the issue of pinning down what a patient means by dizziness
here our patient was fine lying flat but became lightheaded with altered vision on standing
there was also associated nausea & abdominal pain
he was able to move into his flat (with the attendant box lugging) on the saturday
any ideas as to diagnosis?
_ _ _
there seems to be a clear story of postural symptoms, most likely secondary to hypovolaemia
[causes orthostatic hypotension?: diabetes, drugs, parkinsons, autonomic dysfunction, addisons]
we briefly talked about blood loss
(1 pint is actually a US pint or 473mL, not the UK (imperial) pint of 568mL)
catastrophic blood loss might occur into the gut, lungs, abdomen, pelvis
lethal bleeding (without exsanguinating) into the pericardium or brain
_ _ _
we mentioned the surface markings of the pleura but did not finish the conversation
see here for more
_ _ _
we then went to chat to our patient who has addisons disease
click here for thomas addison's own pictures (he was a physician at guys)
[NB why do people with addisons exhibit hyperpigmentation?]
our patient was first diagnosed in the US 2 months ago
he takes 20mg of hydrocortisone daily as his normal regimen (which he tripled over the weekend)
_ _ _
on examination he had no hyperpigmentation in the buccal mucosa or palmar creases
he had a 15mmHg systolic drop on admission (?now)
his abdomen was soft & non-tender with no masses or organomegaly
_ _ _
on arrival he had a Na of 120mmol/L with a K of 6.8
his ECG showed peaked T waves
he was given calcium gluconate & insulin/dextrose
_ _ _
we briefly mentioned causes of addisons disease:
autoimmune, infection (incl TB), hameorrhage, cancer, congential adrenal hyperplasia, pituitary problems
investigations:
importantly electrolytes, septic screen
_ _ _
things to read about:
1) addisons
2) emergency treatment of hyperK
3) hydrocortisone
Salaam
s
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