Casus1

One Response to “Casus1”

1. 

   Laura January 11, 2013 at 00:18 #

   Only more questions…

   What seems strange is the difference in skin appearance between lower and upper extremities.
   Also, probably she was on Oxygen? Surely her Aa gradient was abnormal with this ABG. Thinking of cellular hypoxia caused by inhaled toxins or cyanide-ish toxins?
   With this obduction report all my first differentials are wiped away. How did the intenstines look? No mesenteric thrombosis / ischemia?
   Could think of metabolic disease (stofwisselingsziekte)? But why now, and induced by what?
   Or acute adrenal insufficiency (induced by acute termination of Prednisolon use)? Normal electrolytes, could be false due to hypovolemia. But low Hb… and normal L and Tr…?
   Central viral infection / spinal cord / brain stem with autonomic dysfunction resulting in hypotension and organ failure? Far fetched…. and why on-off complaints?
   Why did she use two anti-histaminics? What happens if you combine it with a SSRI / MAO inhibitor?
   Hormonal? Thyroid dysfx?

   In the history is mentioned that she had cyanosis and SOB yesterday morning when getting up, and this morning again, after getting up syncope. Could that mean that posture was important? Pressure by organs or collapse of vena cava superior when lying down. But why? Connective tissue disease?
   Can be possible regarding the lung disease (bit young for COPD)?

   Lets ask House.

   Reply

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