Endocrine Case Report: What's the Dif?

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History of Present Illness:

A woman in her early 40s with a history of diabetes mellitus presents to the emergency department for a flu-like illness with multiple symptoms. This morning she woke with chills, subjective fever, cough, and headache, and vomited once. She is also feeling weak all over and has dyspnea, pleuritic chest pain, and epigastric pain. She denies diarrhea, dysuria, or other symptoms.

Vital Signs & Physical Exam:

Vital Signs: Temperature 102.3, Pulse 126, BP 105/45, Pulse-ox 98%. Physical Exam: is notable for a positive jolt sign but no photophobia or neck stiffness, clear lungs, epigastric tenderness and tachycardia.

Initial Diagnostic Testing:

  • CBC: WBC 8.2
  • Chem 7: normal except for glucose 203 and bicarb of 21
  • Imaging: CXR normal
  • Other: UA normal. LP to rule out meningitis normal.
  • Re-eval: Feels a little better. Repeat vitals: Temp 100.1, HR 97, BP 96/55

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