complicated by recurrence of pericardial fluid and tamponade requiring further drainage a few days later. Colchicine, ibuprofen, anti-tuberculous therapy and corticosteroids were started. The patient clinically improved and had resolution of fevers, tachycardia and the pericardial effusion. 8 days after his initial pericardiocentesis, MTB PCR resulted as positive and 3 weeks later, culture grew a mycobacterium species. He was discharged on antiretrovirals, anti-tuberculous therapy, corticosteroid taper, and metoprolol tartrate.
non-specific symptoms and availability of sensitive rapid tests. Tuberculous (TB) pericarditis is a more aggressive disease in HIV-infected patients with greater myocardial involvement and a mortality rate of up to 40%. Thus, early diagnosis and treatment is critical. Furthermore, the World Health Organization reports the number of people infected with tuberculosis rose globally for the first time in years. Louisiana ranks 3rd in the U.S. for HIV cases and consistently ranks in the top 25 in the nation for TB cases; therefore we may expect to see more patients with tuberculous pericarditis.
Discussion: The diagnosis of a tuberculous pericardial effusion may be challenging due to
AN UNFLAGGED RED FLAG: SEVERE DIABETIC KETOACIDOSIS WITH APPARENT NORMOKALEMIA Ashley Van, Arash Ataei, Alex Miller, Jacob Senker, Amy Wolfe, Kyle Happel; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
Introduction: Herein we describe a case of diabetic ketoacidosis (DKA). The clinical presentation generally includes signs and symptoms of volume depletion and metabolic derangements. DKA is defined by the presence of metabolic acidosis, hyperglycemia, and ketonemia. Laboratory evaluation typically reveals an elevated anion gap, low serum bicarbonate, and hyperkalemia. The absence of insulin and the acidemia caused by ketone production both cause serum potassium levels to rise. Urinary potassium excretion drives total body potassium dangerously low despite relatively normal serum concentrations. DKA management generally involves hydration, insulin, potassium repletion. Case: A 32-year-old woman with no medical history presented for one day of fatigue with several days of nausea, vomiting, and abdominal pain. She was afebrile, normotensive, tachycardic, and tachypneic. On exam, she had rapid, deep respirations. EKG revealed a prolonged QT interval. Initial labs included the following: pH 6.86, potassium 3.6 mmol/L, glucose 890 mg/dL, CO2 6 mmol/L, anion gap 25 mmol/L, and a ß-hydroxybutyrate level of 6.1 mmol/L.
Aggressive potassium repletion was initiated prior to insulin therapy, and over the course of five days she required more than 600 mEq of potassium. Discussion: This case demonstrates the importance of closely monitoring key data points and using clinical reasoning to guide management. Understanding the pathophysiology of insulin deficiency and potassium balance in DKA is crucial. At initial glance, this patient appeared normokalemic. However, DKA is a state of total body potassium depletion with patients typically appearing hyperkalemic, as the absence of insulin causes intracellular potassium to shift out of cells. Therefore, a patient that appears normokalemic with profound acidemia is likely severely potassium deplete. This patient’s intractable vomiting and polyuria likely resulted in further potassium loss and drove her total body potassium even lower. These potassium levels in conjunction with her EKG changes were a potentially fatal combination. While clinical picture and history are important, it is crucial to monitor lab changes in DKA to prevent life-threatening complications.
FAKE IT ‘TIL YOU MAKE IT: SIMULATION-BASED PROCEDURAL TRAINING FOR NEW RESIDENTS Yazdi Fereshteh, Mohammed Hassaan Khan, Oluwadamilola Adisa, Audrey Netzel, Atlee Baker, Shreedhar Kulkarni; Department of Medicine, Louisiana State University, Shreveport, LA.
Introduction: Simulation-based health care training has gained popularity in the last two decades as an effective way to practice technical procedures without compromising patient safety.
We assessed the confidence level and competency of first year internal medicine residents at Louisiana State University Hospital in Shreveport before and after undergoing simulation-based training 30
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