Remember when we used to share "good cases!" on here? Well, here's one.

[RustedFox]

That’s some nonsense. Has your medical director not addressed that with the nursing admin?

Our nursing leadership is assinine.

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[gutonc]

Our nursing leadership is assinine.

That sentence is one word too long. I'll let you decide which word should be cut.

 

[Vandalia]

That sentence is one word too long. I'll let you decide which word should be cut.

Actually, I think it could work if you considered every word as the "one word too long."

 

[Raryn]

Sodium down. K+ up.
...
So I started dopamine while I drew all the fancy ass tests that make the endocrinologists turgid. No response. Only person I've ever seen have their HR go down on dopamine and BP not change.

...

Best part, the endocrinologist came down and said "I know it looks like addison's crisis. but its NEVER addisons crisis." Said that to me the same day. And went ahead and made his note a few days later at patient DC say that this isnt addisions its an unspecified pan-hypopituitary syndrome with secondary adrenal involvement. Which. my lord. <makes hand-jerk motion>. Nerds. All of them. Nerds.

Good call. Forgive my people for being nerds - we just get a lot of incorrect diagnoses thrown at us, and it's refreshing to see a real one.

That said... if the patient truly had Hyperkalemia as part of her presentation, I'd be very surprised if the issue was pituitary in origin and not primary adrenal disease - the RAAS system is well-preserved in central AI and the potassium is never affected. Obviously, if the ACTH is low in this scenario and he thinks it's central it's probably central, but it doesn't smell right to me.

 

[RustedFox]

Good call. Forgive my people for being nerds - we just get a lot of incorrect diagnoses thrown at us, and it's refreshing to see a real one.

That said... if the patient truly had Hyperkalemia as part of her presentation, I'd be very surprised if the issue was pituitary in origin and not primary adrenal disease - the RAAS system is well-preserved in central AI and the potassium is never affected. Obviously, if the ACTH is low in this scenario and he thinks it's central it's probably central, but it doesn't smell right to me.

Endocrine has always been my achilles' heel. That, and heme.
I have a profound respect for you guys.

 

[DocEspana]

Good call. Forgive my people for being nerds - we just get a lot of incorrect diagnoses thrown at us, and it's refreshing to see a real one.

That said... if the patient truly had Hyperkalemia as part of her presentation, I'd be very surprised if the issue was pituitary in origin and not primary adrenal disease - the RAAS system is well-preserved in central AI and the potassium is never affected. Obviously, if the ACTH is low in this scenario and he thinks it's central it's probably central, but it doesn't smell right to me.

That patient was a flaming mess anyway. She left AMA when no one would treat her neck pain the way she wanted.

The one thing I'd say is our stories are always just a snapshot. Diseases are dynamic. We can get confounding variables making the ED visit atypical but the entire inpatient stay follows the rules more.

 

[Raryn]

That patient was a flaming mess anyway. She left AMA when no one would treat her neck pain the way she wanted.

The one thing I'd say is our stories are always just a snapshot. Diseases are dynamic. We can get confounding variables making the ED visit atypical but the entire inpatient stay follows the rules more.

Regardless, good catch.