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WBC & Lactate

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 40-ish-year-old male with a history of bowel obstruction and marijuana use presents to the ED for vomiting and severe generalized abdominal pain and tenesmus.    He denies fever, diarrhea, bleeding or other complaints

Vital Signs & Physical Exam:

Vital signs are normal except for   Physical exam is otherwise normal except for severe distress.  Abdomen is benign

Initial Differential Diagnosis:

  • obstruction
  • cannabinoid hyperemesis

Initial Diagnostic Testing:

  • CBC: WBC  = 30
  • Chem 7: bicarb = 15, lactic = 7.5, CRP and ESR normal, ABG: pH 7.65 with pCO2 of 12
  • Imaging: KUB and CT abdomen both normal

QUESTIONS:

  1. What do the lab results suggest?
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What do the lab results suggest? Respiratory alkalosis with metabolic compensation.  Demargination.  Severe vomiting from CHS or AKA can cause these type of impressive lab values.  They should be associated with normalish vitals and imaging and a benign abdominal exam and return rapidly to normal.  If not consider other causes.
  2. What should you do next?  Culture, no ABX, admit for obs, hydrate and treat symptoms.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

PLACE PAGE HERE

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CASE CONCLUSION: We’ll just have to see

CASE LESSONS:

  1. Never
  2. Always
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