superior axis. She was taken for coronary angiography later that afternoon to assess any ischemic etiology of her new unstable angina. However, the study was negative. Following a series of unrevealing imaging studies, including transthoracic echocardiogram, non-contrast chest CT, and cardiac MRI, the evaluation concluded with a cardiac MRI showing evidence of dilated cardiomyopathy but lacking an infiltrative disorder. The patient was ultimately discharged with a wearable defibrillator and scheduled for follow-up in the electrophysiology
clinic after completing a repeat treadmill stress test while on 50 mg of metoprolol succinate without triggering another run of ventricular tachycardia. Discussion: This case is remarkable in the extent of symptomatology experienced by the patient’s tachyarrhythmia which presented similarly to obstructive coronary disease, and the lack of supporting evidence for a physical
abnormality or pathology that may have contributed to the patient’s presentation.
MELAS SYNDROME AS A PREDISPOSING FACTOR TO DKA Ty Theriot 1 , Charles Woodall DO 2 , School of Medicine 1 , Department of Medicine 2 , LSU Health New Orleans, New Orleans, LA.
Introduction: MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes) syndrome is a rare mitochondrial disorder that can affect various systems in the body, including the pancreas, that presents with recurrent episodes of encephalopathy, myopathy, headache, and focal neurological deficits. Case: A 40-year-old woman with type 2 diabetes, multiple episodes of euglycemic and hyperglycemic diabetic ketoacidosis (DKA), and MELAS presented with nausea, vomiting, and abdominal pain for two days. The day prior she experienced > 10 episodes of yellow-colored emesis. She also experienced umbilical and epigastric abdominal pain without recognizable aggravating or relieving factors. She also endorsed experiencing subjective fever, chills, palpitations, generalized weakness, and headache since this episode began. Patient adherent with prescribed Lantus, Gabapentin, and Keppra. Initial blood glucose of 313 mg/dL and urinalysis positive for 100 ketones. Beta-hydroxybutyrate 44.79 mg/ dL, lactic acid 2.0 mmol/L. Hgb A1C was greater than 14.0%. A diagnosis of diabetic ketoacidosis was made.
The patient was treated with daily basal insulin, a diabetic diet, moderate-dose sliding-scale insulin, and continuation of anti-seizure medications. Discussion: Multiple episodes of DKA in this patient may be attributed to her history of MELAS syndrome. MELAS syndrome can lead to a malfunction of the mitochondria in cells, including those in the pancreas which can lead to alteration of the production and release of insulin. Lactic acidosis, a common complication of MELAS syndrome, can affect acid-base balance and potentially lead to metabolic acidosis exacerbating DKA. People with MELAS syndrome may have weakened immune systems, making them more susceptible to infections. Infections are a common trigger for DKA in individuals with diabetes, as the stress and inflammation associated with infections can increase blood sugar levels. MELAS syndrome leads the body to rely more on fatty acid metabolism. This can increase the production of ketones contributing to the development of ketoacidosis in diabetic patients.
EARLY ONSET NORMAL PRESSURE HYDROCEPHALUS: SHOULD WE EXPECT THE UNEXPECTED Harrison Travis 1 , David Crochet MD 2 , Carl Giffen MD 2 ; LSU School of Medicine1, Department of Medicine 2 , LSH Health, Baton Rouge, LA.
Introduction: Normal Pressure Hydrocephalus (NPH) results from chronic, progressive accumulation of cerebral spinal fluid that expands the ventricles in the brain, leading to neurologic symptoms. Patients classically develop symptoms of impaired gait, worsening cognition, and urinary incontinence. While prevalence is debated, it is generally a disease of the
aging population with a cited prevalence of 1.3% in patients 65 or older and 5.9% in those 80 or older.
Case: A 53-year-old man presented following a fall at his home. A previous fall two weeks earlier prevented him from returning to work due to his instability. He also complained of persistent urinary incontinence
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