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Ogólnopolskie Forum Studentów Medycyny i Lekarzy

Dr House - Acceptance 02x01 PDF Print E-mail
Author: majlinka
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Thursday, 01 October 2009 22:09

A prisoner condemned to death, starts having hallucinations about his victims during a basketball game. He starts to run around his cell trying to free himself from his visions until he falls down. He has tachycardia. His heart starts beating so fast it pumps out air instead of blood. Curious isn't it?

During an examination in a cell a doctor affirms bluish tinge to the fingernails and lips. Upon auscultation the doctor found fluid in the patients lungs, breathing rate of 50, so he needs to be intubated and put on a respirator. Because there is no respirator in the prison the patient was transported to a hospital.

Suspicion no 1: The guy's probably a heroin addict, which explains the tachycardia, which caused a pulmonary edema. They tested his hair, blood and urine for traces of opiates, but found none, the patient does have low natrium levels. During the next examination the patient became aggressive and got a 2 milligram ativan shot. The staff commissions an arterial blood gas test from the femoral artery. The results: pH 7.28 and decreased HCO3 - acidosis.

Suspicion no 2: he was taking INH - drug for tuberculosis. Chase goes to the patients cell, trying to find something extraordinary and finds a copier fluid. In meantime his heart rate's dropped to 30, atropine was administered.

Suspicion no 3: He's been drinking the copier fluid which contains about 90% methanol, enough to kill him. But since he started to drink whisky with House the ethanol has saved him. 

They also take a CT, LP to check for intracranial lesions, brain infections,autoimmune diseases. In CT no lesions, no aneurysms.

When they decided to sent him back to prison he started to bleed from the lower region of his colon. The surgery went fine. They removed almost a foot of necrotic bowel.

The solution of this case is an interpretation of his mental state, looking for the reason why he killed all those people. There were : jealousy, revenge, ''retribution''and fury. So what's the differential for such aggressiveness? Excess testosterone, steroids. Adrenaline! The diagnosis - pheochromocytoma. Pheochromocytoma  sits on top of the adrenal gland, randomly spits out oodles of adrenaline. It explains everything: the tachycardia, pulmonary edema, the vasoconstriction that cause the necrotic bowel...

Is everything "fine" with this case? Let's discuss about it!

 

Comments  

 
+1 #1 Mountain Man 2011-02-04 17:00
a blood test for high glucose would likely confirm pcc, test for metanephrine to confirm. The only thing is where do the hallucinations come in to play? seems they would be more neurological than endocratic
 
 
0 #2 Mateusz Palczewski 2011-02-04 17:24
And you probably have answer for author's last question. I don't see relevance between hallucinations and pheochromocytom a neither.
 
 
0 #3 player13.presh 2011-05-09 18:03
perhaps the suicides are linked...fluctuations in the adrenaline levels could cause depression?
 
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