When Constipation Reaches its Breaking Point

​BY ALEJANDRO E. MACIAS; BILLY ZHANG; KRISTEN HUGHES; SHAMIM KHAN, MD; FRANCISCO JACOME, MDA 73-year-old man with a past medical history of hypertension, type 2 diabetes, and hyperlipidemia and a surgical history for a coronary artery bypass presented with sudden, severe lower abdominal pain. He characterized his pain as 8/10 and was tender to palpation.Laboratory studies showed a white blood cell count of 7.51 with a glucose of 759, no bands, a platelet count of 230,000, and a lactic acid level of 6.7. Urinalysis showed +5 ketones and a glucose count of greater than 500. An abdominal CT showed possible microperforations around the cecum. The patient also had electrocardiogram changes indicative of an abnormality in the inferior wall of the heart. The patient was given 1 g of ertapenem and 1 g of ceftriaxone, and was placed on a bicarbonate drip. The clinical impression at this point was shock (septic vs cardiac).The patient was taken emergently to the catheterization lab to rule out acute coronary artery disease. Severe three-vessel coronary artery disease, totally occluded third vein graft, and moderate to severe reduced left ventricular function with an ejection fraction of 30 to 35 percent were found. The patient was transferred to the intensive care unit, where he was evaluated by surgery. His blood pressures was in the 70s, and he was tachycardic and tachypneic. A central line was placed and dobutamine, levophed, and two liters of normal saline were administered with ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research