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