Polycythemia left undiagnosed or untreated may result in a number of sequelae including myocardial infarction or cerebral vascular accidents. While the diagnostic criteria, classification, and workup are established, many practitioners fail to either initiate the process or perform the correct workup. Most clinicians are familiar with polycythemia and its respective clinical encounters, nevertheless, the fact that it is so frequently misdiagnosed or improperly worked up necessitates additional education. This case report covers three practical clinical examples of outpatient polycythemia, and their respective workups Furthermore, this publication will discuss the diagnostic criteria laid out by the World Health Organization and the confusion regards complications based on etiology.
Prolonged malnourished states can predispose patients to refeeding syndrome with the uncommon complication of cardiogenic shock if not corrected initially. While refeeding syndrome is well studied its complications may not be easily identified in the setting of rapid deterioration. This case report reviews the events of a 57-year-old male who was brought in by law enforcement, for altered mental status and agitation, after being found wandering in the woods. The patient was initially hemodynamically stable but developed cardiogenic shock from sick sinus syndrome. The patient's shock was non-responsive to IV fluid resuscitation and required ICU admission. Congestive heart failure, ischemic cardiomyopathy, substance abuse, myocarditis, and endocarditis were considered but ruled out. Patient's symptoms improved after electrolyte repletion following brief ICU admission with dopamine drip.
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