Order Description
Let?s Play ?House?
Case Scenario
A 28-year-old female is brought to the ER by Emergency Medical Services (EMS) after being found sitting at the side of the road, incoherent and disoriented. In the ER, she is uncooperative and combative. She is not oriented to self, place, or time. Security is called to help restrain her, and she is placed in five-point leather restraints for her own and the staff?s protection. No specific complaints can be elicited from the patient; she continues to yell at the staff and seems to be having auditory and visual hallucinations. Her temperature is 102.5 F, heart rate 120 bpm, and blood pressure 185/100 mmHg. An abrasion is noted over her left temple area and when she arrived to the ER, her hands were in an unusual position as demonstrated in the picture below:
A Foley catheter is placed, and red-tinged urine is obtained. Laboratories were obtained showing:
Na 124 mEq/L
K 5.9 mEq/L
Cl 95 mg/dL
BUN 15 mg/dL
Creatinine 1.9 mg/dL
Serum Osmo 268 mOsm/kg
Ca++ 7.2 mg/dl
Phosphate 5.2
Albumin 4.1 mg/dL
AST (aspartate aminotransferase) 1,636 u/L
Alanine aminotransferase (ALT) 399 u/L
WBC shows leukocytosis but no left shift
Hct and hgb are normal.
1. What is the likely diagnosis? Was there anything specifically noted in the above information that made you decide on this diagnosis?
2. What other differential diagnoses were considered in this client? Why/how did you rule them out?
3. Describe the pathogenesis behind the abnormal findings found on physical exam.
4. Evaluate her laboratory/diagnostic findings ? how do they relate to this diagnosis?
5. Develop a problem list for this client.
