Case Presentation: A 44-year-old male hospitalized for an extended period with severe diarrhea and polyarthritis developed worsening anion gap metabolic acidosis (AGMA) over the course of 10 days. The patient was being treated for septic arthritis in the background of polyarticular gout with vancomycin, ceftriaxone, colchicine, indomethacin, and acetaminophen. Acetaminophen was dosed as needed on [...]

Case Presentation: A 54-year-old man presented with confusion, vomiting, and weakness. En route to hospital he received dextrose for a glucose of 40. Admitted to the ICU for severe metabolic acidosis. Past medical history included type 2 diabetes, depression and PTSD. Aside from tachycardia, smell of alcohol, and bilateral hand tremor, initial physical exam was [...]

Case Presentation: A 71 year old male presents to the ED with diffuse abdominal pain and nausea for the day. He has an extensive medical history including Type II DM, CAD, HFpEF, and COPD. He was recently prescribed Bactrim for a UTI, but notes persistent dysuria and suprapubic discomfort which prompted him to take an [...]

Case Presentation: A 6mo female with GERD presented with poor weight gain. She was born full-term with a normal newborn screen. Family history was non-contributory. Since birth, she had poor weight gain despite medical therapy . She had large-volume spit ups shortly after eating, prompting GI evaluation. She was developmentally delayed, unable to sit without [...]

Case Presentation: A 76-year-old man with mantle cell lymphoma status post chemotherapy 1 week prior presented to an outside emergency department with generalized weakness. Initial laboratory workup revealed hemoglobin of 8.8 g/dL, platelet count of 3 × 109/L, creatinine 5.55 mg/dL and bicarbonate 7 mmol/L (Table 1). Rectal exam showed brown stool, however fecal occult [...]

Case Presentation: The patient was a 74-year-old male with past medical history significant for atrial fibrillation and Type II Diabetes Mellitus who presented due to 5 days of diarrhea and change in mental status. Per family, the patient had poor oral intake for the past week. Pertinent vitals included heart rate of 123 beats/minute, respirations [...]

Case Presentation: A 54-year-old female with a past history significant for anxiety, tobacco, and alcohol use disorder presented to the emergency department with nausea, dizziness, weakness, and vomiting. Husband reports patient was bit by a dog on her right hand but denies any noticeable wound. He reports on the weekend she also had 2 episodes [...]