CICM SAQ 2010.1 Q27
Question
A 26 year old lady presents from home confused with a low-grade fever. Her blood pressure is 160/100 mm Hg. She has no gross motor deficits. Ten days ago she had an emergency termination of pregnancy for an intrauterine death that was complicated by disseminated intravascular coagulation. She was 32 weeks gestation and had been on labetalol for a pregnancy-induced hypertension.
Her discharge medications included paracetamol, tramadol and a selective serotonin reuptake inhibitor. She has a 6-year history of uncomplicated Hepatitis C.
- 27.1. List the differential diagnoses for her confusion and temperature.
- 27.2. Outline your approach to establishing the diagnosis.
Answer
Answer and interpretation
27.1. List the differential diagnoses for her confusion and temperature.
- Pregnancy related:
— Eclampsia / preeclampsia / HELLP, Retained products with sepsis, Sheehan’s syndrome / pituitary apoplexy, Posterior reversible encephalopathy syndrome (PRES), Hypertensive encephalopathy - Primary neurological:
— Infection (meningitis / encephalitis), cerebral venous thrombosis, seizure disorder, other cerebro-vascular - Metabolic:
— Sodium (hypo/hyper), Glucose (hypo/hyper), Renal failure, Liver failure (HCV / Paracetamol / Antidepressants), - Drugs:
— Accidental / intentional overdose, drug reactions (serotonin syndrome) Infection: Uterine, intracranial, other (renal, chest etc)
27.2. Outline your approach to establishing the diagnosis.
History:
- Collateral, Pregnancy issues, Ongoing blood loss, bleeding / bruising, drug ingestions, mood / affect, headaches
Examination:
- BP, uterine size / discharge, oedema, meningism, neurological (tone, reflexes, symmetry), chronic liver disease
Investigations:
- FBC: Bleeding, platelets, WCC
- UEC: urea / creatinine, Na, Ca, glucose
- Coagulation: DIC, INR for CLD
- LFT / Ammonia: hepatic encephalopathy, drug reactions
- ABG: hypoxia / hypercardia
- Urinary drug screen / paracetamol level
- Sepsis Screen, CT head +/- LP
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC