Published in:
01-06-2015 | Clinical Practice: Exercises in Clinical Reasoning
Exercises In Clinical Reasoning
A Confusing Interaction
Authors:
Urvi A. Shah, MD, Mark C. Henderson, MD, Paul Abourjaily, PharmD, David Thaler, MD, PhD, Joseph Rencic, MD, FACP
Published in:
Journal of General Internal Medicine
|
Issue 6/2015
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Excerpt
A44-year-oldwoman with a history of cerebral palsy, intellectual disability, seizure disorder, and hypothyroidism was brought to the emergency department from her group home for increasing lethargy over the past day. At baseline she was bedbound, nonverbal, and did not follow commands. Her aide reported difficulty feeding her that morning. The patient’s family had recently noted abnormal twitching movements and occasional lateral neck movements to the right during eating, which were unlike her usual seizures. Review of systems was otherwise negative. In the emergency department, she was hypothermic (T 95.3°F) and hypotensive (BP 73/54 mmHg) with a heart rate of 80 beats/min. …
