45 yom, unknown medical problem

[EMT91]

Probably too simple.




Not renal failure.



Lactate is 1.8.




\

The renal failure was just a guess with the s/s. I knew stroke TIA would be too simple lol. Can someone explain this:
Lactate is 1.8.
?

 

[NomadicMedic]

The renal failure was just a guess with the s/s. I knew stroke TIA would be too simple lol. Can someone explain this:
Lactate is 1.8.
?

A serum lactate of 4.0 or greater is a marker that may indicate sepsis.

 

[EMT91]

A serum lactate of 4.0 or greater is a marker that may indicate sepsis.

Perhaps you could PM me and explain Serum Lactates?

 

[NomadicMedic]

Perhaps you could PM me and explain Serum Lactates?

Or you could feel free to google it.

 

[VFlutter]

Hmm maybe some kind of excessive catecholamine dump that finally broke? Or he is bleeding or 3rd spacing fluid somewhere. Abdomen distended / worsening ascietes?

 

[abckidsmom]

Hmm maybe some kind of excessive catecholamine dump that finally broke? Or he is bleeding or 3rd spacing fluid somewhere. Abdomen distended / worsening ascietes?

You are on to something here... Where could an apparent alcoholic get this prolonged altered mental status and catecholamine dump?

 

[VFlutter]

You are on to something here... Where could an apparent alcoholic get this prolonged altered mental status and catecholamine dump?

delirium tremens? However symptoms
Usually don't develop until 2-3 days after the last drink and he drank "a few" today

 

[STXmedic]

Does the wife know of any recent weight-loss?

 

[abckidsmom]

delirium tremens? However symptoms
Usually don't develop until 2-3 days after the last drink and he drank "a few" today

The history from the family was ridiculous.

When we put him on the CT scanner table, I was giving report to the Chief of Neurology of this hospital. Midday on a Tuesday and all, the gang was all available. One of the staff members said, "He looks post-ictal," and that was like a spotlight shining on the guy for me.

This is not my first time following Todd's Paresis down the path of stroke alert, and yet, I totally fell for this dude. He was very convincing, and I think the hypertension really helped a lot.

Turns out, this guy left work on Friday, knowing he was taking a week or two for vacation and intending to quit drinking. He had one last weekend of fun, and stopped drinking Sunday night. He was feeling bad on Monday afternoon, and Tuesday morning was entering DTs. He had a seizure (called back the first responder to get a coherent description now that he wasn't shaking in his boots anymore, and he totally witnessed a seizure.

So, they admitted him for medically supervised detox, kept him on some benzos, and the theory goes that he will live happily ever after, except for his poor shriveled up, ammonia-poisoned brain.

So, all this to say, that's why you don't typically stroke alert people who have confirmed seizure activity.

He would have needed the head CT anyway, she said self-protectively. I don't think the Chief of Neuro minded much, he was really surprised when the CT came out with no big bleed.

I just wanted to share this one because I felt like the clues were there the whole time, but I missed them in the face of the glaring signs pointing at CVA. I learned how important it is to explore all the differentials, not just the one you really think it is.

 

[DPM]

I'm thinking Seizure. Especially after the "It's Cardiac Arrest, no wait it's resp. arrest, well no he's breathing now but etc etc" at the beginning.

Any family history?

 

[STXmedic]

:rofl:

Good scenario, Dana! Thanks! Todd's paresis is a new one for me

 

[NomadicMedic]

Good scenario. Thanks for sharing.

 

[abckidsmom]

:rofl:

Good scenario, Dana! Thanks! Todd's paresis is a new one for me

I first saw it in a 16 month old 27 week gestation NICU grad who was developing a seizure disorder. That sweet girl became a twice weekly frequent flier for us, and she was down on the left during her post-ictal time almost every time.

The first time, I tried to alert her, and the hospital refused, but offered no explanation. It was a steep learning curve, but I learned my lesson then.

Apparently it didn't stick.

 

[abckidsmom]

PS They were going to refer him to vascular for those nasty looking legs. No immediately theories were coming up to explain that red herring.

 

[MadMedic]

Great scenario! Todd's Paresis is new for me too and will be sharing that with all my co-medics. I'm also going to use this for training.

As I read it I was first thinking Stroke, then DT's, thinking 2 beers were not enough for this guy. But some how i missed the seizure all together.

Thanks again for this one, everyday is a learning day, and I learned something today!

 

[EMT91]

Honest to God, I was really thinking seizure but ruled it out due to it not being witnessed. I was thinking---->Acute Renal Failure----->caused a absent seizure------>fell from chair----->got bruised.

 

[Aidey]

Where did you get acute renal failure from?

 

[EMT91]

Where did you get acute renal failure from?

http://www.nlm.nih.gov/medlineplus/ency/article/000501.htm

The symptoms fit at places. Also, one of my instructors said she found a guy with ETOH breath who had kidney failure.

 

[Aidey]

What symptoms in the first post made you personally think that?

 

[EMT91]

What symptoms in the first post made you personally think that?

BP: 230/124
weak and crabby all day
he somehow fell out of the chair
mild abrasions to BUEs
odor of ETOH on his breath, mild jaundice.

ARF lists HTN, AMS, tiredness (could be described as being weak) breath odor, and seizures.