Term 6 Week 6 (w/c 3/6/13)
Thank you for all your contributions to last weeks case. There was lots of discussion and contribution. Also special thanks to our guest contributor.
In response to requests we are starting off with a more generalised ICU question.
You have been called to the ward to review a 35 year old lady who has become acutely unwell complaining of muscle weakness and vomiting.
As you make your way to the ward what are the potential differential diagnoses?
Thank you for your suggestions yesterday.
You review the patient on the medical assessment unit. She presented with non specific abdominal pain, nausea and vomiting. Since her admission she has developed mild muscle weakness and is becoming confused.
The patient is lying on the bed complaining of abdominal pain, she looks dehydrated. HR 135 BP 140/90 CRT 2s Temp 37.5
What are your thoughts now? What Investigations would you request?
Thanks for the suggestions her U&E reveal Na 129 K 3.2 Ur 8.5 Cr 90. FBC Hb 110 WBC 6.5 PLTs 180
The surgical team have reviewed the patient and arranged for an USS. This is unremarkable. With the patient still in pain They would like to undertake a diagnostic laparoscopy.
What are your thoughts now? What else would you like to know?
Amylase is 60 Glucose 6.8
Following discussion a CT abdomen is performed this is unremarkable.
Review of her drug chart reveals that she has been taking paracetamol and diclofenac for pain. She usually takes no medication.
Following return from CT the patient becomes hypertensive and has a seizure.
What are your thoughts now? Whats the plan?
The LFTs are deranged. A plausible diagnosis of Acute Intermittent Porphyria has been made.
How can we confirm the diagnosis?
What implications does this have to us as anaesthetists?
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