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Questions and Answers
What is the main concern for the 33-year-old woman presenting with nausea, vomiting, and significant weight loss?
Which blood result is most concerning for the 33-year-old woman with the described symptoms?
What is the immediate treatment for the 33-year-old woman once her diagnosis is established?
On discharge, what advice should be given to the 33-year-old woman regarding her condition?
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What symptom did the 45-year-old woman present with that could indicate a hyperglycaemic emergency?
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Which laboratory finding might suggest that the 45-year-old woman is experiencing complications of her diabetes?
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What is a common condition associated with the 45-year-old woman who has type 2 diabetes and presents with new palpitations and restlessness?
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What could the combination of her symptoms in the 45-year-old patient indicate?
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Study Notes
Case 1
- A 33-year-old woman presents with nausea, vomiting, fatigue, lack of energy, and weight loss for 6 months
- She has previously been diagnosed with hypothyroidism a year ago and is currently on levothyroxine medication.
- Upon examination, the patient appears pale, listless, dehydrated, and has low blood pressure and a high pulse rate.
Case 1 Blood Results
- Sodium levels are low at 128 umol/L (normal range: 133 - 146 umol/L)
- Potassium levels are high at 5.7 mmol/L (normal range: 3.5 - 5.3 mmol/L)
- Urea levels are high at 16.7 mmol/L (normal range: 2.5 – 7.8 mmol/L)
- Creatinine levels are high at 82 umol/L (normal range: 45 - 84 umol/L)
- Plasma glucose levels are very low at 2.2 mmol/l (normal range: 4 - 11 mmol/l)
- Amylase levels are within the normal range at 42 IU/L (normal range: 30 - 118 IU/L)
Case 1 Investigations & Diagnosis
- Investigations to confirm diagnosis: Measure cortisol levels and ACTH levels.
- Other relevant investigations: Thyroid function tests, full blood count, liver function tests, CT scan of the abdomen.
- Suggested diagnosis: Addisonian crisis due to inadequate cortisol production.
Case 1 Management
- Immediate Treatment: Administer intravenous hydrocortisone (100mg) to replace cortisol immediately.
- Long-term treatment: Lifetime replacement therapy with oral corticosteroids such as hydrocortisone to replace the missing cortisol.
- Patient discharge advice: Educate the patient on how to self-administer steroids, and ensure they have a medical alert bracelet outlining their condition.
Case 2
- A 45-year-old woman presents with high fever, agitation, confusion, and weight loss.
- She has a history of type 2 diabetes mellitus, is on metformin and has had two previous C-sections.
- The patient also reports palpitations, somnolence, and restlessness for a few days.
- Clinical examination reveals agitation, sweaty palms, and abnormally elevated temperature, blood pressure, pulse, and respiration rates.
Case 2 Blood Results
- Sodium levels are within the normal range at 135 umol/L (normal range: 133 - 146 umol/L)
- Potassium levels are within the normal range at 3.8 mmol/L (normal range: 3.5 - 5.3 mmol/L)
- Urea levels are within the normal range at 9.2 mmol/L (normal range: 2.5 – 7.8 mmol/L)
- Creatinine levels are high at 110 umol/L (normal range: 45 - 84 umol/L)
- Protein levels are within the normal range at 65 g/L (normal range: 60 - 80 g/L)
- Albumin levels are low at 42 g/L (normal range: 35 - 50 g/L)
- Bilirubin levels are high at 10 umol/L (normal range unreported but elevated)
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Description
Explore a detailed case study of a 33-year-old woman experiencing significant health issues including fatigue, nausea, and unusual blood test results. The case highlights the importance of investigating cortisol and ACTH levels in diagnosing potential adrenal insufficiency. Engage with specific symptoms and lab results that guide diagnosis and management.
