Tunnel vision strikes again?

[Carlos Danger]

To repeat my anatomy instructor's statement, "The abdomen is a dark and mysterious place full of danger" or words to that effect.

Especially in a young female.....

 

[Carlos Danger]

How in the flaming hades are you figuring that?

If anything I'd be more suspicious for a hypernatremia from volume contraction. I'm betting more along the lines of substance withdrawl/ingestion.

Vomiting can cause hyponatremia. Nausea, lethargy, and seizures are certainly symptoms of it.

Could be from a glucocorticoid deficiency, excessive alcohol consumption without eating (you know the rule....you need to at least double whatever number of drinks they admit to), or any number of other causes.

Or it could be something entirely different.

 

[Handsome Robb]

I don't think these all that volume depleted from one day of vomiting, especially with those vitals. If she's hyponatremic secondary to vomiting she would also be hypovolemic she should be compensating and she's not. She's young, doesn't seem to have any medical Hx unless I missed it somewhere so it's not like her compensatory mechanisms are suppressed (ie beta blockade) or something of the sort.

Did we ever get answers to last menstrual cycle? Any spotting/bleeding? G/P/A? Sexually active? If she is is she monogamous or polygamous? If she's polygamous or if her monogamous partner has she been tested recently? Not many STDs would fit here but questions that need to be asked.

She was complaining of pain as well was she not? Did we hear any more about that pain? OPQRST? Vomiting then pain or pain then vomiting?

Did she go on the monitor?

How's her fluid intake been? She hasn't eaten and that can cause abdominal pain and nausea, I know I get real nauseous when I haven't eaten in a long time, add a hangover to it and you're in for a day. "I only had one shot and one beer." Alright fine, but people lie so we do need to consider that.

Any elicit drug use? Specifically opiates? Opiate withdrawal can cause N/V/D and abdominal pain. Generally you'd see an increased sympathetic tone though with that one.

 

[Handsome Robb]

Also, you said she had a period of unresponsiveness. How was her respiratory effort during this time? What time of the day was this after the "drinking last night"? The reason I ask is GHB ingestions can present with suppressed vitals, lethargy/ALOC and have periods of completely unresponsiveness sometimes accompanied by apnea/bradypnea. Even a small amount of ETOH in conjunction with GHB can have profound effects even hours after the facts in some cases depending on the amount ingested.

I missed it too, where are we? College dorm? Dorm food? Gastroenteritis has to be an option as well. Any melena or blood in her stool? Any family history of GI problems?

No food at all correct? Any sugar or anything? Glucose tolerance tests can cause abd pain and N/V, sugary meal could have the same effect, especially if she's been evaluated recently. With her mentation I'm not 100% going to believe every word she said.

What type of seizure did she have in the ER? Her brief unconsciousness could have been a seizure without tonic-clonic movements.