“Chronic Diarrhea” (cont.)

TSH (thyrotropin)-Receptor Antibodies: Negative Radioactive Iodine Uptake (RAIU) scan: High, multi-nodular uptake The patient was diagnosed with Toxic Multinodular Goiter. She was started on propranolol and methimazole and her symptoms resolved. In one month, her TSH and free T4 levels normalized. She received elective thyroidectomy and was subsequently initiated on levothyroxine. For more, see hyperthyroidism

“Coughing Up Blood” part 2

Patient is intubated for airway protection. She is also resuscitated with 2 liters of IV crystalloid fluids. Initial workup elicits the following: Lab WBC 10.2 (normal differential), Hgb 11.4, Plt 190K Na+ 136, K+ 4.0, Cl– 110, HCO3– 24, BUN 52, Cr 2.6, Glucose 112 AST: 27, ALT 25, Total Bilirubin 0.2, Albumin 3.2 ABG:Continue reading ““Coughing Up Blood” part 2″

“Coughing Up Blood” part 3

This patient has two separate problems: Hemoptysis (with likely Diffuse Alveolar Hemorrhage) and Acute Kidney Injury (with likely glomerulonephritis as evidenced by urinalysis findings) in the setting of elevated inflammatory markers. Diffuse Alveolar Hemorrhage Diagnosed by bronchoscopic alveolar lavage (BAL) obtaining sequential 5mL aliquots that show increasing RBCs Differential Diagnosis: Pulmonary capillaritis Vasculitis Anti-GBM diseaseContinue reading ““Coughing Up Blood” part 3″

“My blood pressure is high” continued

This young male with difficult-to-control hypertension on maximum-dose therapy of two antihypertensives requires a workup for secondary hypertension. Labs WBC 6,400, Hgb 13.6, Plt 245,000 Na+ 146, K+ 2.8, Cl– 110, HCO3– 30, BUN 27, Creatinine 0.8, Calcium 8.5 TSH: 2.4 8 AM Plasma Aldosterone Concentration (PAC): 22 ng/dL; Plasma Renin Activity (PRA): 0.6 ng/mLContinue reading ““My blood pressure is high” continued”

Secondary Hypertension

~10% of cases of hypertension are secondary to another disease process (1). Secondary hypertension should be evaluated in young patients with otherwise-unexplained hypertension or patients with difficult-to-control hypertension. The most common etiologies are: Hyperthyroidism Hyperaldosteronism Hypercalcemia Obstructive Sleep Apnea Renovascular Hypertension Chronic Kidney Disease Coarctation of the Aorta Cushing Syndrome PheoChromocytoma One mnemonic to rememberContinue reading “Secondary Hypertension”

“Blood in My Urine” continued

Nephrolithiasis Urology consulted, performed ureteroscopic stone fragmentation and removal the following day Hypercalcemia Treated with IV fluids, Zoledronic Acid, and Calcitonin -> serum calcium normlized within 2 days Hydrochlorothiazide was discontinued PTH resulted low at 8 pg/mL 25-OH-Vitamin D and 1,25-OH-Vitamin D levels were within normal limits PTHrP ordered, returned a few days later elevatedContinue reading ““Blood in My Urine” continued”