RESUMO
We herein report two cases of patients with thyroid storm with a delayed diagnosis due to psychosis. The patients were a 63-year-old woman with bipolar II disorder and a 37-year-old man with major depressive disorder. The psychoses in both patients were well controlled with medication. Although they both showed symptoms of thyrotoxicosis, the symptoms were ignored, presumably because the psychological manifestations of worsening of psychosis and thyroid storm are similar. When the mental or physical state of patients with psychosis changes, thyroid hormone levels should be measured for early treatment.
Assuntos
Transtorno Bipolar/diagnóstico , Diagnóstico Tardio , Transtorno Depressivo Maior/diagnóstico , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos , Crise Tireóidea/diagnóstico , Crise Tireóidea/fisiopatologia , Hormônios Tireóideos , Tireotoxicose/diagnóstico , Tireotoxicose/fisiopatologiaRESUMO
PATIENT: Male, 66. FINAL DIAGNOSIS: Hypercalcemic crisis. SYMPTOMS: Near drowning state. MEDICATION: - CLINICAL PROCEDURE: - SPECIALTY: Critical care medicine. OBJECTIVE: Challenging differential diagnosis. BACKGROUND: Hypercalcemic crisis, generally caused by malignancy or primary hyperparathyroidism, is a life-threatening emergency that can result in multi-organ failure. Lowering the patient's calcium level immediately and determining the correct etiology are essential. CASE REPORT: We report a case of hypercalcemic crisis with a novel etiology. A 66-year-old male presented to the emergency room in cardiac arrest with a ventricular arrhythmia after being discovered submerged in an indoor public bath. He underwent cardioversion and was emergently intubated. Computed tomography showed bilateral pulmonary edema, suspected from water aspiration. Laboratory data revealed severe hypercalcemia and mild hypernatremia. Following three days of continuous hemodiafiltration, serum Ca decreased to and remained within normal limits. We concluded the etiology of hypercalcemia was absorption of Ca resulting from aspirated water. CONCLUSIONS: Near drowning can be a cause of hypercalcemic crisis. For cases of near drowning, it is important to investigate the source of the aspirated water and consider electrolyte abnormalities in the diagnosis.
