Today we discussed a young woman who presented with intentional aspirin overdose as a suicide attempt. We discussed her presentation, management, and indications for dialysis in treatment of salicylate toxicity.
Today we had an iatrogenic Serotonin Syndrome caused by Linezolid, Morphine & Zofran given in the ED! Be careful of what you give to patients on serotonergic medications!
Today, we had a patient present who presented with chronic progressive L-access arm swelling, facial swelling and headache due to TCVO due to the presence of a TDC & Mediport crowding her SVC. Don’t leave lines in your patient unnecessarily!
Today we had a patient presenting with subacute weakness 6 months after starting a statin and found to have statin rhabdomyolysis. Don’t forget that it can occur at any time (but usually 6 months after starting)!
Today, we had a case of a pt with a remote hx of IBD (not actively flaring or on maintenance medications) who presented with acute onset and rapidly ulcerating skin rash, later found to be pyoderma gangrenosum. One of the key points is to be CAUTIOUS about debridement as it can be harmful due to pathergy
Today we had a patient who presented with Ogilvie’s Syndrome who required Neostigmine for treatment. Remember that delayed treatment can lead to perforation so don’t wait!
Today we had a case of pt with HFrEF who presented with an ACS event c/b LV thrombus causing RLE occlusion requiring amputation
Today, we had a classical case of GBS that required close monitoring of NIFs and reviewed the spectrum of GBS
Yesterday we discussed the case of a young man with no past medical history who presented with subacute onset progressive unilateral facial swelling and B symptoms unresponsive to oral antibiotics
Our differential diagnosis included infectious etiologies (bacterial abscess, EBV, Mumps, TB lymphadenitis), malignancy (lymphoma, squamous cell carcinoma, Burkhitt’s lymphoma), and Lemierre’s syndrome (thrombophlebitis of IJ).
On CT Neck, patient was found to have multiple mandibular abscesses, and apical lung cavitary lesions concerning for septic emboli. While neck ultrasound did not find a thrombus within the internal jugular vein, given cavitary lesions in the lungs, Lemierre’s syndrome was thought to have been the diagnosis.
Today we discussed the case of a young woman with history of bulimia nervosa and secondary ESRD due to recurrent AKIs, who presented with subacute encephalopathy, found to have metabolic alkalosis with partial compensation with respiratory acidosis in addition to concomitant anion gap metabolic acidosis.
- Metabolic Alkalosis – due to emesis
- Respiratory Acidosis- compensatory
- Anion gap metabolic acidosis – Renal failure, given lactate, and beta-hydroxybutyrate were normal.
In this case, we saw that after SLEDD treatment, patient’s metabolic alkalosis and anion gap metabolic acidosis resolved and she was left with her compensatory respiratory acidosis.
A thanks to former chief resident, Dr. Saloni Kumar for her teaching of this material to us back in 2017!