2/10 The rash was insidious in onset, initially involving extremities and progressed to involve rest of the body, sparing face, palms, and soles.
Reports ~40 lb unintentional weight loss in previous 4-5 months.
Ddx for this rash would be : emedicalhub.com/maculopapular-…
3/10
Vital Signs: T-36.2, HR-92, RR-16, BP-109/75
Physical Exam:
Diffuse, erythematous, macular rash involving majority of bilateral upper and lower extremities, anterior and posterior trunk and abdomen.
Left occipital LN 1cm +. Rest of the examination was normal
6/10
Dermatology ➡️ onset of symptoms was within a few days of initiation of allopurinol, 🚫 facial edema, DRESS was considered unlikely.
Reaction thought to be a simple drug reaction/Morbilliform rash.
Prednisone 40 mg Qday started X 5 days and resolution was achieved.
7/10
Morbilliform drug eruption is the most common form of drug eruption. Many drugs can trigger this allergic reaction, but antibiotics are the most common group. The eruption may resemble exanthems caused by viral and bacterial infections.
1/9 #Morningreport this week @SinaiBmoreIMRes
featured an interesting case by N. walia
A young Pt presenting with pancreatitis - develops complaints of "bilateral vision loss with progressively worsening headaches "
DDx ??? #MedTwitter#Medstudenttwitter
2/9 BP noted to be: BP: 207/117
Exam:
Eyes: EOMI.
Cannot count fingers.
Appreciates some movement on the right which appear as shadows.
Unable to detect static objects
Neuro: Exam normal
2/10 Further history:
Unable to swallow any solid food
• “held in the throat”
• coughing frequently
• Generalized malaise
• New left ptosis
3/10EXAM:
T: 36.4°C BP: 139/69 HR: 68 RR: 18 SpO2: 100% on room air
Gen: Awake, alert
HENT: Left ptosis
Neuro: A&Ox3, CN 2-12 grossly intact. Moves all extremities spontaneously, 5/5 all extremities but had some fatigue and dropped to 4/5 with resistance. Cerebeller Neg
2/Other findings were:
-unexplained weight loss.,
- Tachypnea & mild SOB
- Intermittent chronic diarrhea, Intermittent small amount of bright blood per rectum
- Bruises on thighs
Now the DDx shift from the respiratory system to maybe an overlap of a hematologic etiology
2/The DDX for Hypokalemia requires consideration of a 3 pronged approach: 1)Decreased intake 2)Renal and GI losses and 3) IC shifts.
3/For the workup: Spot urine potassium and 24 hour urinary Potassium suggested urinary K wasting.
[UK] high (>40 mEq/L) =renal K loss
TTKG of 9 was concerning for renal potassium wasting
In hypokalemia (K⁺ <3.5 mEq/L), the TTKG > 7 suggests renal K wasting.