A 69-Year-Old Female with Tiredness and a Persistent Tan 英文参考文献.docVIP

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A 69-Year-Old Female with Tiredness and a Persistent Tan 英文参考文献.doc

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A 69-Year-Old Female with Tiredness and a Persistent Tan 英文参考文献

Open access, freely available online Learning Forum A 69-Year-Old Female with Tiredness and a Persistent Tan Petros Perros D E S C R I P T I O N O F C A S E A 69-year-old female presented with palpitations and a history of tiredness and shortness of breath for several weeks. She had a previous history of Raynaud syndrome. She was an ex-smoker. She commented that she had not lost her tan since the previous summer. Her only medication was nifedipine for her Raynaud syndrome. On examination, she was slim and tanned. Pulse rate was 86 beats per minute and regular. Her blood pressure (BP) was 105/74 mm Hg. Her chest was hyperin?ated. The rest of her examination was recorded as normal. A chest X ray showed no evidence of cardiac failure. Electrocardiogram monitoring showed episodes of atrial ?brillation. Her routine biochemistry was as follows: serum sodium, 132 mmol/l (normal range, 135–145 mmol/l); potassium, 5.1 mmol/l (3.4–5 mmmol/l); urea, 8.6 mmol/l (2.5–6.4 mmol/l); and creatinine, 110 mmol/l (65–120 μmol/l). DOI: 10.1371/journal.pmed.0020229.g001 Figure 1. The Patient’s Facial Appearance at Presentation versus after Treatment Facial appearance at presentation (left), showing pigmentation, and after treatment (right). She was commenced on digoxin and warfarin. Her breathlessness gradually improved, and she remained in sinus rhythm. Progress How Would You Explain the Hyponatraemia, and What Additional Investigations Are Required? The patient was admitted into hospital two weeks after the initial presentation. Her main complaints were increasing lethargy and tiredness, reduced appetite, an episode of fainting, and weight loss. On examination, she was pigmented and thin (Figures 1 and 2). Her pulse rate was 76 beats per minute in sinus rhythm. BP was 77/59 mm Hg. The rest of the examination was normal. Hyponatraemia is a common electrolyte abnormality in hospitalised patients [1]. The cause is often obvious (e.g., a clear history of ?uid and electrolyte