Medical scenario
 

Switching gears here.
Here's a good medical call.
The site I got this from has several different diagnosis from its members.
Let's see what the members here come up with.

A 44-year-old woman in moderate respiratory distress for the past two days, she had experienced mild respiratory difficulty, Nausea/vomiting and intermittent vertigo and tinnitus for three days and a headache and back pain for the last week. Her children had complained to her that "she was getting deaf." Low grade temp and has been “In a really bad mood” She appears restless and slightly diaphoretic, Lethargic when not stimulated. Denies Drug or ETOH intake, states she “Can’t remember what meds she has taken today”

PMHX- Bipolar, Sciatica, Fibromyalgia, Migraines, Cardiac w/ 1 stent, HTN

MEDS- Lithium, HCTZ, ASA, Seroquel, Ibuprofen, Gabapentin, OTC Herbals, Indocin

BP- 110/62
HR- 80
RR- 30 labored
SPo2- 90%
Cardiac Monitor- Sinus Rhythm with nonspecific ST-T changes
HEENT- Clear, Headache
Pupils- Clear 3mm
Neck- Clear
Chest- Clr, no pain
Lungs- Diffuse Rales Bilaterally
Abd- Clear
Pel- Clear
Neuro- Clear

What is your Differential DX?
What will your treatment be?
Any Special Concerns or considerations.

I am thinking a couple of things are going on here. Most immediate is CHF (diffuse bilateral rales) but also drug interaction/overdose (Seroquel/HTZ/Gabapentin) could give these symptoms. RO hypokalemia. I would admit this patient and get blood chems to RO hypokalemia. Chest films to RO CHF. Control meds to eliminate overdosage and drug-drug interaction.

Ooooh, interesting thought ;) What do you think the proximate cause for this would be? Too many Tums :D

I forgot to include to RO pneumonia in the DDx too.

Remember Doc, this is "Pre-hospital" where we don't have the luxury of labs to treat our patients. We just have the above scenario to work with. ;)

Just wanted to see what different diagnosis we'd come up with over here.
So far so good.
Keep 'em coming folks. :munchin

PE
 

Pulmonary embolism is in the DDX

Ahhh, Man your no fun :p Do we at least get to know the outcome?

Didn't report any thoracic petechiae on physical exam :p

I am going with a chronic, moderate to severe lithium overdose. Patient is taking numerous medications that cause increased Li concentrations. HCTZ, Ibuprofen, Indocin, gabapentin, and even some OTC herbals all increase serum LI concentrations.

The HCTZ is one of the main culprits seen in interaction overdoses when used by itself. Combining HCTZ with the ingestion of three other KNOWN causes of increased Li levels has to make you consider Li toxicity in your differential diganosis. That is before you even factor in the unknown "herbal" meds that also can increase serum Li levels...


Also, most if not all pertinant findings in history and physical can be onserved in Li toxicity.

:munchin

Yes, I'll post up the outcome later on.

..... and it's YOU'RE ....

Holy crap .... I am no fun, aren't I ????:eek:

:D:D

Agree with Lithium toxicity #1. Also have to rule out salicylate toxicity as well.

History and physical sound more tox but need to consider posterior stroke as well as aortic/carotid dissection.