4/21/17 Intern Morning Report – Diarrhea, Hyponatremia, Cryptosporidia

CC: RUQ pain and diarrhea x 6 weeks

ID: 58 yo male with HIV/AIDS (CD4 25) off HAART who presents with 6-8 weeks of persistent cramping, non-radiating RUQ pain, and watery diarrhea.  He was found to have hypovolemic hyponatremia and ultimately work-up revealed cryptosporidium.

Capture

Source: MKSAP 17


Pearls from morning report:

  • Blastocystis species are commonly detected in stool samples, but it is unclear whether this parasite is truly pathogenic. In symptomatic patients who are immunocompromised, a thorough examination for infections and noninfectious causes should be performed. If the work up is negative, then treatment with blastocystis with metronidazole is a reasonable option
  • Ecstasy can cause drug-induced ADH secretion leading to hypotonic hyponatremia.

Random trivia:

Cryptosporidium is the most common cause of recreational water illness outbreaks – caution next time you go to Raging Waters!


Want to read more?

Disorders of Plasma Sodium – Causes, Consequences, and Correction (New England Journal of Medicine)
Hyponatremia (New England Journal of Medicine)


References: 

Sterns RH, Emmett M, Forman JP. Diagnostic evaluation of adults with hyponatremia. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on May 3, 2017)

Sterns RH, Emmett M, Forman JP. Causes of hyponatremia in adults. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on May 3, 2017)

MKSAP 17: Medical Knowledge Self-assessment Program. Philadelphia : American College Of Physicians, 2016. Print.

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