Sporadic and tachycardic

23 05 2013

infrequent. sporadic. intermittent.

my posts are like these. am a big procrastinator.

the primaries are in 83 days again.

(flunked anatomy and physiology…ouch)

 

anyway would put relevant cases I see with my primaries.

 

 

Saw a Cat 2 2 days ago.

22 y/o F. Palpitations HR 170.

right…. straightaway comes to mind SVT ain’t it ?

 

brought to Resus. Adenosine drawn up, my senior doing cannula and bloods.

and then I saw the patient’s mum carrying 2 things in their hand :

a. Path results from 1 week ago showing T3 of 30 ; TSH < 0.01

b. Carbimazole

 

 

hmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

 

turns out this poor lass has been sick for the last 1 week with nausea/vomiting/headaches/URTI symptoms. NO rigors though and only could manage her carbimazole half the days. Had bloods with her GP and endocrinologist 1 week ago and only got the results on that day – her endo asked her to take 60mg carbimazole and see him in 1week’s time.

she had palpitations from the onset of 1400 pm and couldn’t sleep. (didn’t tell her mum until her mum saw her being pale and SOB)

 

HEr BP was 140/90 Sats 99% on R RR20 and Temp 36. NO focal signs of infection. CXR normal.

BLooods reassuring show normal K / renal function and her ECG showed a sinus tachy of 130.

 

Settled with some fluids to 125. but she felt palpitations still…..

 

 

SO…not SVT.

probably palpitations from sinus tachy precipitated by URTI +- UTI (Urine stil pending) ; complicated by hyperthyroidism.

We ended up given lots of anti emetics and made her chug some propranolol and another 20mg carbimazole and admitted under telemetry

Lessons learnt:

 

a. A little bit of thyroid physiology revised.

Spent 7 minutes watching this video :

http://www.youtube.com/watch?v=2qYBzjtm2SA&list=PLIho5L33Je9QbGSBHr18xmrNNPOiR1SNx&index=1

b. Antithyroid medications.

 

Revised carbimazole/prophylthiouracil


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