Tamingthesru

Annals of B-Pod Ryan LaFollette, MD Annals of B-Pod Ryan LaFollette, MD

B Pod Case Reports: 22 Year Old with Difficulty Swallowing

Chief Complaint

Difficulty Swallowing

History of Present Illness

The patient is a 22 year old female with no significant past medical history who presents to the ED with a chief complaint of dysphagia.  The patient first noticed difficulty swallowing solid foods 2 weeks ago. She states that she felt like food was getting caught in her throat.  Initially she only had difficulty swallowing solid foods and was able to eat soft foods and liquids.  However, she reports that over the course of two weeks her condition gradually worsened to the point where she could no longer tolerate fluids. She states that she has pain in the back of her throat when she attempts to swallow.

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Jeffery Hill, MD M.Ed Jeffery Hill, MD M.Ed

Grand Rounds Recap - 10/8/2014

Quarterly Sim with Dr. Frank Fernandez

82yoF with multiple medical problems including Grave's Disease who accidentally stopped her Synthroid arrives altered, hypothermic, and bradycardic.

Differential diagnosis for profound hypothermia is fairly short: Environmental vs. Hypometabolism (sepsis is typically a mild hypothermia)

  • The typical myxedema coma precipitants are infection, medication changes, or cold weather
  • Sepsis + bradycardia, should make you think about hypothyroidism
  • Consider evaluating hypothyroid patients for other metabolic issues as they are often co-morbid, especially SIADH
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