Rejected for custody due to negative tan.

mycrofft

mycrofft

Still crazy but elsewhere
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Homeless man living outdoors is arrested for drunk and disorderly. He is skinny, obtunded, smelly, dirty, and somewhat suntanned. VS : slightly elevated temp, BP quite elevated with mildly elevated pulse, pupils ERL but sclera are noted to be "orangish". Upon exam he has obvious old needle tracks on the backs of his hands and between the fingers. Upon rolling up his long dark shirtsleeves, it is noted that he has a much deeper bronzy tan under his shirt than on his exposed hands and face and neck.
Doctor says "Don't book him, call an ambulance. Start an IV of SNS TKO, if you can find a vein". (We didn't find one). He was unconscious when the ambulance got there ten minutes later.

What was the MD's clinical reason for not having the man become an expense for the sheriff department?
 
Something tells me that this guy isn't drunk... and if this guy becomes an expense for the Sheriff's Department, he's going to be very BIG expense.

I'm thinking thyroid storm or liver failure from viral hepatitis (or at least something along those lines).

Oh, and the bilirubin is broken down by light... the skin that was shielded by the clothing retains it's color.

As some theater tech friends of mine used to say: "This could be BAD."
 
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Sounds like a viral hepatitis. Some of the other symptoms point toward a thyroid storm.
Also could be a hepatitis induced by excessive drinking over alot of years.( and drug abuse)
Candidate for IO if not able to gain vein access.
What is the abdomen looking like? Is there swelling? Was there any tenderness while he was awake?
What does the monitor show?
Pulse ox?
BG?
Respirations?
Does the local cops know anything about the guy's pattern of life?
Could be a cocktail of stuff. Something is afoot, Watson.
 
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Bingoed. Hepatic failure.

The "reverse tan" was sort of neat.
No hx due to LOC and we never saw him again that we knew of, but a blood spec the doc had drawn was hard to test due to the concentration of bilirubin, according to the lab. (The bili can throw off colorimetric reagent tests becuase it is such a strong coloring agent. Ask me about mastiffs and leather tanning sometime).
Belly was a little pooched, we didn't have pulse ox back then, and our curiosity was appeased by the decision to call for transport.
 
Don't know if he had Addison's.

Once we established he needed hospitalization and didn't pose a public threat, he was released before his booking was completed.
 
Hepatic failure

;).............
 
Was this a jail-based clinic that you work in?
 
Retired thanks.

It was correctional health care, which included intake screenings, sick call, man downs, pill calls, treatments, detox, diabetic stabilization, patient education, immunizations, and OB/GYN.

ETC
 
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