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Post by pbruss on Sept 3, 2015 15:00:42 GMT -5
patient i saw down in southern ohio recently/ 65 yo lady with no pmhx come in with weakness diffuse muscle aches and fatigue. gradual onset over past month. on exam has wired rash (see pic) and diffuse muscle tenderness which is mild. this is not the first time she has had this. both her and her husband get these weird symptoms about 2 or 3 times a year for the past 5 years, ever since they moved into a new house. usually the go the the ER, get worked up, find nothing, then go live with her sister for a week because the need help getting around the house. then the symptoms always resolve and they go back home and start they cycle all over again. her labs show she is slightly anemic. what do you think? Attachments:
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Post by tyson on Sept 3, 2015 17:03:49 GMT -5
lead or copper poisoning?
what did CBC differential show? any basophilic stippling?
MCV?
interesting....
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Post by pbruss on Sept 3, 2015 19:06:01 GMT -5
i dont have the exact lab values but you are close. what if hr nails looked like the attached picture? Attachments:
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Post by pbruss on Sept 7, 2015 15:18:32 GMT -5
arsenic poisoning from contaminated well water.
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Post by tyson on Sept 7, 2015 17:28:55 GMT -5
is arsenic a lab you can send off from the ED and get it back same day or how did you definitively diagnose that?
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Post by pbruss on Sept 8, 2015 5:13:44 GMT -5
yeah so i didn't diagnose this lady. i suggested to the husband that it may be a heavy metal poisoning and ordered a lead level that was a send out but she went home from the ER. just by chance i saw the husband for something different and he told me he called "someone form the county" to come out and test his well water and it was "loaded" with arsenic".
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Post by DD on Sept 8, 2015 13:11:19 GMT -5
I figured you would have smelled it
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Post by erinto on Sept 11, 2015 9:23:32 GMT -5
Cool case-saving lives, Dr. Bruss, saving lives
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