UnFiNiShEd CaSe CoMe BaCk LaTeR
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History of Present Illness:
A 22-year-old female with a history of bipolar disorder presents to the ED for 1 week feeling dizzy and a heavy period and 2 weeks feeling off balance and having trouble reading saying that the words are running together. She denies any double vision or other language difficulties. She feels a bit off balance. She denies or other complaints
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is otherwise normal
Initial Differential Diagnosis: drug toxicity, stroke, depression
Initial Diagnostic Testing:
- CBC: normal except for
- Chem 7: normal
- Imaging: Brain MRI normal
QUESTIONS:
- What other lab test should you consider?
- What should you do next?
- Want a 1-minute consult/tutorial on this case?
- Want to know what happened with this patient?
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ANSWERS:
- What other lab test should you consider? Lithium level was critical at 1.6 (normal 0.6-1.2)
- What should you do next? Treat with normal saline. Admit for observation.
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- Want to know what happened with this patient? See case conclusion below tutorial page.
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CASE CONCLUSION: Was admitted and treated with NS and lithium was held. Symptoms gradually improved
CASE LESSONS:
- Always consider medication toxicity in drugs where levels are monitored. Also, consider medication side effect after ruling out other causes