Chest Pain in the Setting of Altered Mental Status

Yuen Lie Tjoeng, Megan Mickley, Kimball Prentiss

Research output: Contribution to journalArticle

Abstract

We report on a young adult female presenting with altered mental status and chest pain. Timely review of her electronic medical record revealed a history of panhypopituitarism with poor medication adherence, although this was unknown at the time of her initial evaluation. The patient required hormone replacement and significant fluid resuscitation, followed by definitive treatment with a pericardiocentesis. She was discharged home on hospital day 4, with normalization of her diminished left ventricular ejection fraction at her 1-month follow-up. Although panhypopituitarism and cardiac tamponade are rare diagnoses, we highlight the management of severe hypothyroidism, the importance of early administration of hydrocortisone for panhypopituitarism, and the need for aggressive volume expansion to maintain preload in cardiac tamponade.

Original languageEnglish (US)
Pages (from-to)181-184
Number of pages4
JournalPediatric emergency care
Volume33
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Keywords

  • cardiac tamponade
  • chest pain
  • myxedema coma
  • panhypopituitarism

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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