Hot Seat #205: Denouement

Posted on: March 2, 2023, by :
205. Q1: [LESS THAN 3 YEARS PEM EXPERIENCE] What is your leading diagnosis? (Poll Closed)
  •  
     
  •  
     
  •  
     
  •  
     
  •  
     
 
Total Votes: 13
205. Q1: [MORE THAN 3 YEARS PEM EXPERIENCE] What is your leading diagnosis? (Poll Closed)
  •  
     
  •  
     
  •  
     
  •  
     
  •  
     
 
Total Votes: 12
205. Q2: [LESS THAN 3 YEARS PEM EXPERIENCE] Would you order a head CT? (Poll Closed)
  •  
     
  •  
     
 
Total Votes: 12
205. Q2: [MORE THAN 3 YEARS PEM EXPERIENCE] Would you order a head CT? (Poll Closed)
  •  
     
  •  
     
 
Total Votes: 11
205. Q3: [LESS THAN 3 YEARS PEM EXPERIENCE] What is your disposition for this patient? (Poll Closed)
  •  
     
  •  
     
  •  
     
 
Total Votes: 13
205. Q3: [MORE THAN 3 YEARS PEM EXPERIENCE] What is your disposition for this patient? (Poll Closed)
  •  
     
  •  
     
  •  
     
  •  
     
 
Total Votes: 11

This week’s case features a baby with altered mental status, transferred to us for further workup and management. Our discussion focused mostly on the broad differential here, including toxic ingestion, seizure, arrhythmia, reflux, anaphylaxis, FPIES, and others. It highlights the difficulty in disposition for patients who are back to baseline after an extensive workup that did not reveal any underlying pathology. Our patient here was ultimately discharged home with a tentative diagnosis of anaphylaxis, prescribed an EpiPen Jr, referred to allergy/immunology, and recommended to not consume any new dairy products pending evaluation by an allergist. One week later, the patient had not had any recurrent symptoms and was awaiting his outpatient A/I evaluation.