Case report
Transcript: Day 2 Had not used any alternative or complementary medicines DD - Abdominal Pain Extra - abdominal (4) Acute abdomen with ileus cholecystitis Diverticulitis Pancreatitis Acute hepatitis- viral? Alcohol?... Mesenteric event Thank you Lead Poisoning Temperature 37.3 BP 110/68 Weight 81.8, BMI 25.8. Pitting edema of ankles and varicosities Day 4 Pain worsens with eating Intermittent constant Constipation- 2 days Causes of Dysgeusia The following day, 2 days after presentation outpatient clinic His partner did not drink from that set of mugs or use the spoon. Our paitient worked from a home office Incomplete RNA degradation and abnormal ribosomal structure Reflects impaired hemoglobin synthesis or impaired iron incorporation into heme Causes: Sideroblastic anemia (MDS, alcohol-induced sideroblastic anemia…) lead poisoning Arsenic poisoning Some thalassemias TTP DD Source of lead poisoning? What's next ? 59 y Epigastric distress, no weight loss ,no use of NSAIDs Ankle edema Personal stress, difficulty sleeping, dysgeusia and nausea. Anemia , normocytic (Hb-9.9), RDW ALT, AST Examination… Treatment Day 2 Oxycodone and ondansetron were administered. Avoid acetaminophen and alcohol Acute porphyria Generally Inherited Deficiency in enzymes required for heme synthesis. Categorized according to clinical presentation - neurovisceral or cutaneous principal source of overproduction of porphyrins and porphyrin precursors (typically, the bone marrow or the liver) Can be triggered by starvation, drugs or alcohol, smoking, infections, and other forms of stress. Day 3 DD Causes of Bashophilic stippling Because of the inhibition of ALA dehydratase and the overproduction of ALA- patients with lead poisoning present with features that are similar to those of patients with acute porphyria. Indeed, plumboporphyria, a porphyria that is caused by a deficiency of ALA dehydratase, is named for “plumbum” (Latin for “lead”) because symptoms of the condition mimic those of lead poisoning, but plumboporphyria is rare and is generally reported in children. Confirmed by measuring the blood lead level: 10 μg per deciliter or higher is considered elevated in adults The level may be higher than 100 μg per deciliter in patients with acute lead poisoning, which is much less common than chronic lead poisoning Diagnosis of lead poisoning DD Abdominal Pain +Elevated LFT (3) Diagnosis : gastroenteritis, possible peptic-ulcer disease and a bleeding ulcer. Omeprazole and sucralfate Tests for : Blood in the stool Antibodies to Helicobacter pylori in the blood Upper endoscopy - scheduled Follow up in 3 days, or sooner if condition worsened. What's next ? The next day , 5 days after initial presentation outpatient clinic Abdominal pain (“lead colic”), nausea, dysgeusia, constipation, colonic pseudo-obstruction, joint and muscle pain, behavioral and cognitive changes, acute anemia, basophilic stippling, SIADH, and decline in level of phosphorus (renal phosphate wasting) Lead lines- are not a reliable indicator of acute lead poisoning; absent in this patient. Deposition of lead in bones may be seen with long-term exposure, as may hypertension and neuropsychiatric effects Lead poisoning vs. acute porphyria The next day…. Day 2 Diagnosis must explain: Colonic pseudo-obstruction Acute anemia without apparent GI bleeding Acute hyponatremia, m/p SIADH The next day…. At the same night… ER Lead poisoning vs. acute porphyria Drank wine frequently, but from standard wine glasses, not special leaded glasses He used antique Russian cloisonné spoon to stir his coffee each morning for the past year and drank his coffee from an Italian glazed mug . Back to work...:) Upper endoscopic examination : Hiatal hernia Nodularity in the duodenal bulb. Interior designer and stated that he was never in a building during the renovation process, making exposure to lead from paint dust unlikely. Day 4 Chemotherapeutic agents Other drugs, such as albuterol, histamine H1-receptor antagonists, penicillamine, metronidazole, pirbuterol Exposure to pesticides and other toxins, such as lead poisoning Zinc deficiency Calls his doc. Pain in both legs Stool became looser, with out hematochezia or melena. Radiography of the abdomen – dilated colon, with findings suggestive of stool in the right and transverse colon to a transition point in the proximal descending colon. CT of the abdomen and pelvis, after the administration of contrast material- large amount of stool in the cecum and no evidence of obstruction. He was admitted to this hospital. Day 5 Chelation treatment with calcium disodium EDTA for 4 days, followed by treatment with 2,3-dimercaptosuccinic acid (succimer) for an additional 14 days. Abdominal pain, constipation, and mental-status changes all completely resolved within 2 days after the initiation of chelation treatment. After the patient completed the treatment, the liver-enzyme abnormalities and anemia resolved. Lead level has steadily declined but has not yet normalized (?)
Prezi Present
Prezi Video
Prezi Design
