M&M Extravaganza - Dr. KEller
Lip and facial swelling - Angioedema to the Max!
Our New Scope is found in Room 1 of pixis- "endoscopy storz'.
Attached to cmac to black plug,
29 yo bilateral leg pain
1. Resusucitate/supportive care
2. Identify cause with appropriate lab ordering
3. Empirically give Thiamine 500mg IV
4. Consider empiric Fomepizole after tox consult
5. Sodium Bicarbonate is controversial
6. When in doubt, call nephrology and dialyze
-- Heavy etoh use with a recent binge, sudden cessation with abd pain, N/V. GI symptoms seen in 80%.
-- Present with Absent ETOH level and Anion Gap metabolic acidosis.
-- Due to increased betahydroxybutyrate ketone body, UA does not pick up ketone bodies on dip.
-- Rarely will see severe lactic acidosis and if present think sepsis, seizures or thiamine deficiency.
Pyruvate cannot enter TCA cycle causing high lactic acidosis resulting in Dry (neurologic) and Wet (cardiac) Beriberi. Also causes Wernicke (triad of AMS, opthalmoplegia, and ataxia seen only in 10% of patients).
At risk- etoh, iatrogenic, aids, malignancy, gastric bypass, TPN
44yo fall from standing
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