An Unusual Case of Multiorgan Failure
Background
A 70-year-old woman was recently set in the hospital for a right hip fracture, weakness, and inveterate atrial fibrillation with a speedy ventricular response. Two days after she was discharged to a long-term care facility, she is readmitted for urinary retention and recurrent tachycardia. In addition, she complains of generalized weakness and midplane lower abdominal pain. She denies any prior history of urinary retention, as well as experiencing any fever, dysuria, hematuria, vomiting, trouble breathing, or chest pain in association with this presentation. Her past medical and surgical history includes a stroke with left hemiparesis, hypertension, atrial fibrillation, epilepsy, and hemiarthroplasty; she is nonambulatory secondary to the stroke. Her medications include atorvastatin, enoxaparin, levetiracetam, metoprolol, omeprazole, and warfarin (7.5 mg daily).
On somatic examination, the patient is in distress secondary to her abdominal pain. She is hypotensive, with a blood pressure of 73/45 mm Hg, and tachycardic, with a heart rate of 180 bpm. No fever is mention (temperature, 98.9°F). Her oxygen saturation is 97% on 2 L per minute. Her head, neck, and pulmonary examinations are all normal.
The heart rate is rapid and periodically irregular, but no jugular venous dilation or peripheral edema is detected. She has abdominal wall bruise from enoxaparin injections. The abdomen is firm and diffusely tender to palpation, without rebound or guarding, and hypoactive bowel sounds are noted. On neurologic examination, an unvaried chronic left hemiparesis is found. The rest of the physical examination is unremarkable.
investigating: A complete blood cell count (CBC) and metabolic panel reveal leukocytosis (28.1 kU/L), anemia (hemoglobin 7.3 gm/dL, hematocrit 21.1 %), hyperkalemia (5.9 mmol/L), renal insufficiency (creatinine 1.6 mg/dL, blood urea nitrogen (BUN) 32...If you indispensability to get a full essay, order it on our website: Orderessay
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