In reviewing this case, one thing that stood out is the patient’s presenting hypoglycemia without a known diagnosis of DM. She has dry, thin hair consistent with her known history of hypothyroidism. On exam, the patient is alert, able to follow commands, though oriented to person only. She does not have a known history of DM thus the cause of her presenting hypoglycemia is unclear at this time. Patient has a past medical history significant for hypothyroidism, anemia, and prior Cesarean-section with hemorrhage. This is a 54-year-old female who was found unresponsive and hypoglycemic with altered mental status. ![]() The patient was treated with dextrose 50g intravenously and regained consciousness.Ī diagnostic test was then done, which confirmed the patient’s diagnosis. Representative images from the patient’s computed tomography of the head, showing no acute disease.Īpproximately an hour after arrival to the ED, the patient became unconscious and could not be aroused. Representative images of the CT are shown in Image 3. A chest radiograph (Image 2) and computed tomography (CT) of her head were obtained. Her electrocardiogram (ECG) is shown in Image 1. Genital exam showed normal female genitals with pubic alopecia. The patient was unable to participate in detailed cranial nerve testing. Neurological exam revealed an awake patient oriented only to self and able to follow simple commands. There were 2+ pulses throughout all the extremities and all were warm, well perfused and without evidence of tenderness to palpation. The extremities did not have any edema or evidence of trauma. The patient’s abdomen was soft with normal bowel sounds and without distention, tenderness, rebound, guarding, or organomegaly. Cardiac exam revealed a regular rate and rhythm, without murmurs, rubs, or gallops. Lungs were clear to auscultation with equal breath sounds bilaterally. Pupils were three mm, equal, round and reactive to light. Examination of the head, eyes, ears, nose and throat showed that the patient was normocephalic and atraumatic, without evidence of intraoral or external trauma. Her body mass index was 18.5kg per meter squared. She was breathing 16 breaths per minute with an oxygen saturation of 100% on room air. She had a temperature of 98.5° Fahrenheit with a heart rate of 60 beats per minute, and a blood pressure of 146/82 mmHg. Physical examination revealed a well-developed, thin woman resting on a stretcher. A complete review of systems could not be obtained due to the patient’s altered mental status. The friend stated that the patient had not had any recent injuries, headaches, illnesses, or sick contacts. The patient’s friend stated that the patient does not smoke, drink alcohol, or use recreational drugs. The patient works as a custodian and lives with her son, a recent high school graduate. She had no known drug allergies and her last known menstrual period was before the birth of her son. ![]() ![]() Her only known medication was levothyroxine (dose unknown). Her friend was adamant that the patient has no history of diabetes mellitus (DM). Her past medical and surgical histories included hypothyroidism, anemia and a Cesarean section 17-years prior, complicated by postpartum hemorrhage. ![]() She regained consciousness, but continued to be altered during her transport to the ED. They gave her 50 gm of dextrose intravenously because her capillary blood glucose was 17 mg/dL. When paramedics arrived at the scene, the patient was unresponsive. A few hours later, the friend heard a loud thud and subsequently found the patient unresponsive on the floor. Her friend, who accompanied the patient to the ED, reported that the patient had been “feeling unwell,” vomited twice, and then went to bed earlier that day. The patient was unable to offer any history, so all information was obtained from her friend, paramedics, and past records. X)Ī 54-year-old woman presented to the emergency department (ED) with a complaint of syncope. University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland University of Maryland Medical Center, Baltimore, Maryland
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |