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 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
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.