Admission Note: Endocrinology

I. HHS

Present Illness:

This 76-year-old female had former iron deficiency anemias, thrombocytopenia, and goiter.

This time, she suffered fall-stimulated buttock pain3 days ago and bilateral leg weakness. At our ER, the random glucose was 972 mg/dL. Besides, brain CT showed symmetrical bilateral cerebral hemispheres but without abnormal increased density or hematoma. CXR noticed no cardiomegaly or active lung lesion. The lab data depicted WBC13.9 10^3/uL, Hb11.2 g/dL, platelet 42 10^3/uL, CRP2.8 mg/L, Na125.3 mEq/L, K5.59 mEq/L, BUN72 mg/dL, creatinine2.68 mg/dL, serum ketone negative, and blood osmolality 346 mOsm/kg. Notwithstanding, no feveror cold sweating, general malaise, weight loss 5 kg, polyuria and polydipsia were remarked recently. Under the impression (HHS; buttock contusion), she was admitted to our metabolism ward for further assessment and management.

Ⅱ. Adrenal insufficiency

Present Illness:

This 56 y/o man had previous HCV related2+ years liver cirrhosis,20+ years Type 2 DM, 10+ years hypertension, and ESRD onregular hemodialysis QW 1, 3, 5 at Liou-ying Chi-Mei Hospital in November 2009. He was frequently admittedattributed to Type 2 DM with hypoglycemic coma in the recent half month.

According to his family, he suffered frequent hypoglycemia in recent 2 weeks and received Lantus 18 units QD for DM control since September 16, 2010. AC and PC blood sugar (mg/dl) was: 223~350; 24~38. Conscious change and cold sweating were his family-certified. He visited Liou-ying Chi-Mei Hospital and shifted to Lantus 16 units since November 13 and 12 units since November 21 but in vain. Intermittent hypoglycemia rested. His afternoon sweats appeared; so did weakness before consciousness loss (病人表示多在中午過後開始出現盜汗, 全身無力然後失去意識). There was no fever, chills, nausea, abdomen or chest pain, URI or UTI symptoms, or recent contact or travel history noted. He received radio stations-sold medicine電台藥物for general soreness for years. The moon face, thin skin and ecchymosis over extremities were manifested for months. He was transferred to our endocrine OPD for further survey and recommended to have in-hospitalDM control. Hence, he was admitted for further appraisement and arrangement.

Ⅲ. DKA

Present Illness:

This 40 y/o man working for六輕工業區theNo. 6 Naphtha Cracker Industrial Plantwas diagnosed other type DMand on oral antidiabetic treatment, beside alcoholism-caused chronic pancreatitis, didnot take medication regularly, suffered severe cough since one week ago, and visited LMD (local medical doctor)who diagnosed pneumonia. Sequently, the coughwith chest pain got worse before fever, so he visited our ER.

At our ER, his vital sign was stationary. The lab findings manifested metabolic acidosis, ketosis, leukocytosis, high CRP and blood sugar, hyperkalemia, suspecting DKA. The CXR revealed right lower lobeconsolidation and left upper lobe cavitary lesion;the chest CT, lung abscess formation-complicatedRML and LUL necrotizing pneumonia. Insulin pump for DKAand avelox for lung abscess wereapplied. He was admitted for further conduct.

Ⅳ. Hyponatremia

Present Illness:

This 81 y/o female of HTN, a right femoral neck fracture s/p ORIF in April 1999, and aleft femoral intertrochanteric fracture s/p ORIF with DHS on 8-14-2008 was bedridden.

This time, for poor intake, epigastric pain for 4-5 days, and fall-caused pain in the left hip in recent days, she was brought to our ER when the GCS E4V5M6, BT 36.2 degree C, breath sounds, bilateral coarselung markings, abdomen fullness, no tenderness, and a left abdominal clearulcerwound without discharge were denoted, beside leukocytosis, hypokalemia, hyponatremia (K 2.60/NA 112.5 via iv N/S fluid and ivKCL 20 meq), and no fever, dizziness, or tarry stool. Under the impression of hyponatremia, hypokalemia, and suspected gastric or duodenal ulcer, she was admitted for further appraisal and guidance.

Ⅴ. Hypokalemia

Present Illness:

The 34 y/o male with bilateral leg weakness, weight loss, hand tremor and palpitation one year ago came to LMD at whose clinic thyrotoxicosis was impressed for T4 >25 and TSH 0.007; thence, tapazole 1# TID relieved the symptoms. Consecutively, the drug compliance became poor. According to him, the last time he took anti-thyroid drugs was about half year ago.Intermittent hand tremor, weight loss, palpitation, and bilateral thigh weaknesswere avowed this morning. Other associate symptoms incorporated heat intolerance, dyspnea, insomnia and leg edema. He was sent to our ER where K 2.0 mg/dL, free T45.15and TSH 0.03 were divulged. Under the impression (hyperthyroidism andhypokalmeia), he was admitted for further assessment and administration.