35-year-old lady presents with AGMA, AMS, Dizziness, Ataxia, Slurred Speech.

powernephron
Published on Dec 1, 2022
CC-35-year-old lady presents to ER with Altered Mental status, Dizziness, Ataxia, Slurred Speech.

HPI - Symptoms of Altered Mental status, Dizziness, Ataxia, Slurred Speech occurred a few hours after she attended a luncheon party where she also consumed alcohol. Similar episodes of milder ataxia, slurring of speech, confusion occurred in the past while at home and she sleeps it off and feels better next day. Over the past 3 weeks she also noticed worsening diarrhea, bloating, flatulence. Only recent medication is addition of Amitriptyline for anxiety and Vicodin for pain symptoms a month ago.

PMH/PSH - Non-small-cell lung cancer, Obesity, lobectomy, S/p bariatric Ileo-jejunal bypass, Anxiety, GERD, HTN

HOME MEDS - Amitriptyline 50mg –daily (started 1 month ago), Protonix, Norvasc, Vicodin

EXAM - BP 135/80, Gen Exam - confused, dysarthria, and ataxic, No focal neurologic findings, Rest of examination was normal

LABS -
UA, urine Tox screen negative , Urine ketones Neg, Serum Lactic acid - normal

Stool studies - no infection. LFT, serum Ammonia- normal

ABG – Ph 7.15, HCo3 12, PCO2 – 28

CSF – study NEG, Serum Osmolal gap- Normal

Serum ketones, ASA- NEG

NA -142, K 3.7, Cl 110, Bicarb 12, BUN 25, Cr 1.1,

BG 145 WBC 15, HGB 8.9, HCT 31, Platelet 175

IMAGING - CT scan Brain –NEGATIVE, MRI/MRA Brain- NEGATIVE

All of the following are appropriate next steps in management of this patient except?

A. Breath Test after oral carbohydrate loading
B. stop Amitriptyline
C. check for serum alcohol.
d. check for D-Lactate.
e. Stop Vicodin

CLIKC ON LINK BELOW FOR ANSWER

https://renal.medcase.com/free_cme/35-year-old-lady-presents-with-ams-dizziness-ataxia-slurred-speech/