Acute Onset of Lactic Acidosis
Here is a case of a 71 year old woman with a history of CAD s/p left carotid endarterectomy, pulmonary hypertension on tadalafil and Home O2 therapy, symptomatic cholelithiasis, HTN, DM II (A1c 7.3%) presenting with two days of right sided flank pain. Described as sharp and constant, it radiates up to lower scapula border […]
Severe CAP- review of IDSA/ATS guidelines
48 yo F brought into ED for severe SOB with respiratory distress after 3 days of URI/flu like symptoms, SOB and cough. While in the ED she tires out and goes into respiratory failure needing intubation and mechanical ventilation. We reviewed the current combined IDSA/ATS guidelines for the follwing issues: Criteria for admission to the […]
Candidiasis threatening airway
We discussed a 48 yo M with HIV who was admitted for progressive worsening pain and swelling of his throat and neck with odynophagia over the preceding couple of mos but worse over the past 2 weeks. He was seen at an outside clinic 10 days prior to this for similar symptoms and treated with […]
Flush the clog?
A very intellectually stimulating discussion of a 52 yo M with alcohol overuse hx, with a new presentation of abdominal pain with distension over a course of 3 weeks which on further evaluation was found to be ascites with portal hypertension and subtle signs of cirrhosis. Abdominal US with doppler revealed thrombosis of the main and […]
Air where it’s not supposed to be
Today we talked about a 60yF (NH resident) with quadriplegia, dementia, IDDM, hx of staghorn calculus found to have emphysematous cytitis and pyelitis. – it is a rare but severe condition with high mortality without appropriate management – DM is a risk factor – determine management plan and prognosis by CT classification based on extension of gas into/ […]
Recurrent Episode of SOB
We discussed a 47 year old M with history of morbid obesity, non-ischemic CMY (EF 60%), pulmonary HTN, PE/DVTs, OSA on CPAP who presented with a 2 day history of shortness of breath. He reports chills, associated pleuritic chest pain as well as a productive cough of brownish sputum. Of note, one week prior to […]
Alcoholic Hepatitis
44 y/o Male presents with progressive jaundice and hyperbilirubinemia after last drink 6 weeks prior. Following exclusion of an obstructive process the likely etiology was determined to be alcoholic hepatitis. This patient did not feel much sicker than usual but by validtaed scoring tools, had a 30 day mortality > 40%. The review article below […]
Blackout in a can
A 19 yo M presenting with non specific complaints of nausea/ vomiting/ abdominal pain and diffuse bodyache and foind to have an AG metabolic and respiratory acidosis with lactate of 13.2 and pH of 7.04. We went through the differential diagnosis of above which included methanol/ ethylene glycol/ isopropyl alcohol amongst others. This patient had […]
Abd Pain in Peritoneal Dialysis: So special?
59 y/o M with hx of ESRD on PD & recurrent pancreatitis of unknown etiology presents with cc of abdominal pain. What diagnosis should you always be considering? How do you assess the peritoneal effluent (diasylate, not ascitic fluid)? What is the best mode of treatment: intraperitoneal or intravenous? Is there an association or increased […]
LLQ Pain with a Twist
A young 24 year old gentleman with history of GERD on omeprazole presented with worsening LLQ pain for the past month. Described as “deep and aching”, it was non-radiating and exacerbated with meals. Additionally, he had associated nausea and non-bloody emesis with resolved non-bloody loose stools over the past week prior to admission. He denies […]