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“Chief Complaint: Lethargy” … Case Conclusion February 6, 2012

Posted by Andy Jagoda, MD in : Cardiovascular, Gastrointestinal, Hematologic/Allergic/Endocrine Emergencies, Renal and Genitourinary Emergencies , add a comment

The Conclusion Is…

The local Poison Control Center was promptly contacted and the controversies, risks, and benefits of HBO treatment were discussed. The local HBO center was contacted and because of its close proximity and because the patient had evidence of end-organ damage, the decision was made to transfer the patient for treatment. She received an aspirin for her ECG changes and was transferred with ongoing NBO therapy. The HBO treatment was provided without complication. The patient was admitted to the medical service, after which she underwent 2 additional “dives” during her hospitalization. Her 6-hour troponin I level peaked at 2.1 mg/L, and an ECG obtained at that time had returned to her baseline. Subsequent cardiac biomarkers were obtained 12 hours after presentation and were normal. She remained hemodynamically stable and free of symptoms during her hospitalization. After undergoing stress echocardiography testing on hospital day 2, which did not reveal evidence of reversible myocardial ischemia, she was discharged on hospital day 3. At a 6-week clinic follow-up appointment, she denied any symptoms and had a normal examination. However, she said she had sold her apartment and moved in with her son’s family.

Congratulations to Dr. Aziz, Dr. Garcia, Dr. Koury, Dr. Luvetz, and Dr. Stanley — this week’s winners of Emergency Medicine Practice’sAdvances In Diagnosis And Management Of Hypokalemic And Hyperkalemic Emergencies!” For an evidence-based review of the etiology, differential diagnosis, and diagnostic studies for detecting hypokalemia and hyperkalemia, read this issue.

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