Once in a while, I've wish I had a medical discussion board--a place I can bounce ideas off of people, get unofficial opinions without having to bug a consultant, or just to discuss interesting patients. For example, I PM'ed Cardiac a while back about disposition of AFib patients after cardioverting them--just a question I had thought about but didn't have a patient to consult on. We have enough medical expertise here (surgery, cardiology, orthopedics, family medicine, pharmacy, physical therapy--am I missing any?) that I think we could pull this off. Obviously, anyone can post, but to distinguish this one from the medical question thread, this one's more for shop talk.
So...interesting patient the other day--30ish woman comes in completely gorked. Quick blood gas shows a pH of 6.95, pCO2 30ish. Sugar of 125. BMP comes back with bicarb "<5". Normal ETOH. Numbers look like a toxic alcohol, but the patient does not look at all the type. The serum osmolality is a send out, which makes me wonder why it even exists. Ethylene glycol and methanols are obviously send-outs (I haven't been anywhere where they aren't). Cr is 1.45, so this is really looking toxic alcohol. Started treating empirically with fomepizole (ethylene glycol Tx) and arrange for dialysis, still thinking there's no way this is ethylene glycol (I know the family well).
Anyway, just checked on the outcome--turns out she finally admitted to drinking a bottle of antifreeze in a suicide attempt. You just can't judge a book by its cover.
So...interesting patient the other day--30ish woman comes in completely gorked. Quick blood gas shows a pH of 6.95, pCO2 30ish. Sugar of 125. BMP comes back with bicarb "<5". Normal ETOH. Numbers look like a toxic alcohol, but the patient does not look at all the type. The serum osmolality is a send out, which makes me wonder why it even exists. Ethylene glycol and methanols are obviously send-outs (I haven't been anywhere where they aren't). Cr is 1.45, so this is really looking toxic alcohol. Started treating empirically with fomepizole (ethylene glycol Tx) and arrange for dialysis, still thinking there's no way this is ethylene glycol (I know the family well).
Anyway, just checked on the outcome--turns out she finally admitted to drinking a bottle of antifreeze in a suicide attempt. You just can't judge a book by its cover.
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