Rhett’s Blog

Learning Case

Yesterday, a young man came into the ER with fever, sweating, confusion, nausea, and a bit of loose stool. He was acting very lethargic and was soaked with sweat. Physical exam was normal except for some abdominal tenderness throughout the abdomen. I was trying to think about what could be the cause rather than what needed to be done right then, but I did start some fluids and gave him something for fever and went to think. After I wrote the note it seemed obvious that he needed to be admitted and observed overnight, but it just didn’t click in my mind immediately; blame it on being so green in medicine I guess. Well, we got him admitted and started pumping fluids in him. The big problem was that the nurses were trying to call someone to come into the lab, but nobody would answer their phone. I had never admitted a patient at the hospital either and wasn’t sure of the process so I had the nurses call the attending physician, but he wouldn’t answer either. Later on I found out they called the wrong number, but I thought it was crazy people weren’t answering the phone. Well anyway, I just admitted him like I would any other patient in the US. As I checked on him again when I was done writing my notes he was like a totally new person; no more confusion or lethargy. I was a bit shocked, but glad to see him turning around. I guess I just hadn’t had the experience of seeing someone who is dehydrated with confusion then having them totally change just from giving them a bit of fluids. This morning, after the lab technician showed up, I found out that he had amebic dysentery. I ran a CBC, BMP, Stool O&P, and a UA. I also threw on a malaria test and dengue because I wasn’t sure what he had although those were unlikely possibilities, but he had only had a bit of loose stools and he was complaining of muscle and bone aches (His urine was also pink in the morning, but I later found out that was due to a medication (B complex) that they mix in the IV fluid. He had cysts in his stool that I was able to look at with the lab tech. This was the first case of entaomeba histolytica I had had so I was grateful for the experience. I sent him home this morning with Metronidazole and some other medication to kill the cysts (All their medications are in Spanish and couldn’t find a translation, but the Dr. confirmed it was the right one to use). The attending had showed up that morning and he seemed okay with all that I had done. He mentioned not to order so many tests with locals because they can’t afford it. I’m not used to ordering only the bare meager amount of tests, so that’s going to be a challenge. Plus, not being used to the exact symptoms of some of these tropical diseases makes it harder to narrow down the tests. I guess I better study up a bit, because I’ve already seen a few dengue fevers and now amebic dysentery, so hopefully I’ll have many more things that are rarer in the U.S. Until next time. . .