Case History
1
Description: A 26-year-old patient who came to the emergency room because she was feeling
weak with a headache.
PAST MEDICAL HISTORY: Not remarkable
HISTORY OF PRESENT COMPLAINT: This 26-year-old patient has been suffering from headache
and weakness that has lasted over a week. Upon the insistence of family members, she came
to the emergency room.
PHYSICAL EXAMINATION:
GENERAL: This is a 26-year-old female. She is responsive and had no fever.
CHEST: Normal respirations.
CARDIOVASCULAR: Elevated heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is no swelling.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a non-smoker and a vegetarian.
FAMILY HISTORY: Father and sibling are diabetic.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
9.0 x 10-6 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
1
Case History
2
Description: A 66-year-old patient who came to the emergency room because he was nauseous
and vomiting.
PAST MEDICAL HISTORY: Not remarkable
HISTORY OF PRESENT COMPLAINT: This 66-year-old patient has been nauseous and vomiting
for a few days. He is feeling lethargic.
PHYSICAL EXAMINATION:
GENERAL: This is a 66-year-old male. He is confused and had no fever.
CHEST: Normal respirations.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is no swelling.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a smoker and drinks alcohol daily.
FAMILY HISTORY: Unknown.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
3.3 x 10-6 mol/L
7.5 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
2
Case History
3
Description: A 45-year-old patient who came to the emergency room because she complaining
of muscle weakness and paralysis of her lower legs.
PAST MEDICAL HISTORY: The patient has been diagnosed with Bipolar disorder [a mood
disorder in which feelings, thoughts, behaviors, and perceptions are altered in the context of
episodes of mania and depression].
HISTORY OF PRESENT COMPLAINT: This 45-year-old patient exhibited a stumbling walk that
has developed into muscle weakness and paralysis of her lower legs.
PHYSICAL EXAMINATION:
GENERAL: This is a 45-year-old female. She is responsive and had no fever.
CHEST: Low respiration rate.
CARDIOVASCULAR: Normal heart rate and low blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is no swelling.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a non-smoker and a vegetarian.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
1.6 x 10-3 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
3
Case History
4
Description: A 62-year-old patient who came to the emergency room because she was feeling
weak with a headache.
PAST MEDICAL HISTORY: Patient has been diagnosed with high blood pressure. She is on
medication and is currently well-controlled.
HISTORY OF PRESENT COMPLAINT: This 62-year-old patient has been suffering from headache
and weakness that has lasted over a week. Upon the insistence of family members, she came
to the emergency room.
PHYSICAL EXAMINATION:
GENERAL: This is a 62-year-old female. She is responsive and had no fever.
CHEST: Not remarkable.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is minor swelling of lower extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a non-smoker and drinks alcohol occasionally.
FAMILY HISTORY: Mother and maternal grandmother had chronic renal failure [Slow
progressive loss of kidney function over the span of years, resulting in permanent kidney
failure].
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
6.9 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
4
Case History
5
Description: A 52-year-old patient who came to the emergency room because he was feeling
weak with a headache.
PAST MEDICAL HISTORY: Patient has been diagnosed with congestive heart failure [a condition
in which the heart's function as a pump is inadequate to meet the body's needs].
HISTORY OF PRESENT COMPLAINT: This 52-year-old patient has been suffering from headache
and weakness that has lasted over a week. Upon the insistence of family members, he came to
the emergency room.
PHYSICAL EXAMINATION:
GENERAL: This is a 52-year-old male. He is responsive and had no fever.
CHEST: Not remarkable.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is minor swelling of lower extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a smoker and drinks alcohol occasionally.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.0 x 10-1 mol/L
Case History
5
Case History
6
Description: A 3-year-old patient who came to the emergency room because she was lethargic
and irritable.
PAST MEDICAL HISTORY: Unremarkable
HISTORY OF PRESENT COMPLAINT: This 3-year-old patient has been lethargic and irritable
since her recovery from a recent bout of diarrhea.
PHYSICAL EXAMINATION:
GENERAL: This is a 3-year-old female. She is responsive and had no fever.
CHEST: Not remarkable.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is minor swelling of all extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a nonsmoker.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.9 x 10-1 mol/L
Case History
6
Case History
7
Description: A 48-year-old patient who came to the emergency room because he was feeling
weak with a headache.
PAST MEDICAL HISTORY: Patient has been diagnosed with high blood pressure. He is on
medication and is currently well-controlled.
HISTORY OF PRESENT COMPLAINT: This 48-year-old patient has been suffering from headache
and weakness that has lasted over a week. The patient also complains of an increased thirst
and frequent urination.
PHYSICAL EXAMINATION:
GENERAL: This is a 48-year-old male. He is responsive and had no fever.
CHEST: Not remarkable.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is no swelling of extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a non-smoker and drinks alcohol occasionally.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
1.0 x 10-2 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
7
Case History
8
Description: A 57-year-old patient who came to the emergency room because she was feeling
dizzy with a headache.
PAST MEDICAL HISTORY: Patient has been diagnosed with high blood pressure. She is on
medication and is currently well-controlled.
HISTORY OF PRESENT COMPLAINT: This 57-year-old patient has been suffering from headache
and weakness that has lasted over a week. The patient also complains of an increased thirst
and frequent urination.
PHYSICAL EXAMINATION:
GENERAL: This is a 57-year-old female. She is responsive and had no fever.
CHEST: Not remarkable.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is no swelling of extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a non-smoker and drinks alcohol occasionally.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
0 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
2.8 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
8
Case History
9
Description: A 42-year-old patient who came to the emergency room because she was
confused and vomiting.
PAST MEDICAL HISTORY: Patient has been diagnosed with high blood pressure. She is on
medication and is currently well-controlled.
HISTORY OF PRESENT COMPLAINT: This 42-year-old patient was discovered confused and
vomiting by her daughter. The patient also exhibits pale, bluish skin that is cold and clammy.
PHYSICAL EXAMINATION:
GENERAL: This is a 42-year-old female. She is unresponsive and had no fever.
CHEST: slow breathing (fewer than eight breaths a minute).
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is no swelling of extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a smoker and drinks alcohol daily.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
7.6 x 10-2 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
1.9 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
9
Case History
10
Description: A 21-year-old patient who came to the emergency room because he was fatigued
with difficulty walking and speaking.
PAST MEDICAL HISTORY: Not remarkable
HISTORY OF PRESENT COMPLAINT: This 21-year-old patient has been suffering from fatigue
with difficulty walking and speaking. These symptoms have been getting progressively worse
over the last month.
PHYSICAL EXAMINATION:
GENERAL: This is a 21-year-old male. He is responsive and had no fever.
CHEST: Not remarkable.
CARDIOVASCULAR: Normal heart rate and normal blood pressure.
ABDOMEN: Not remarkable.
EXTREMITIES: There is notable swelling of extremities.
Rest of review of systems is not remarkable.
SOCIAL HISTORY: The patient is a nonsmoker and drinks alcohol daily.
FAMILY HISTORY: Noncontributory.
Laboratory Data
Alcohol [ethanol]
Calcium
Chloride
Copper [Total]
Glucose [Fasting]
Iron
Magnesium
Potassium
Sodium
3.3 x 10-6 mol/L
2.2 x 10-3 mol/L
1.0 x 10-1 mol/L
3.5 x 10-5 mol/L
6.0 x 10-3 mol/L
2.1 x 10-5 mol/L
8.6 x 10-4 mol/L
4.6 x 10-3 mol/L
1.4 x 10-1 mol/L
Case History
10
Case History
Case History
11
11