zeeec2000
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19 female ER with intractable vomiting. PHx of Bulimia and she is taking care by psychiatrist . she admit occasional taking ipecac and laxative but denies alcohol or drug. Denies any previous hx of chest pain heartburn, hematemisis or fever. PMx only for COC.
Exam: poor skin turgor thyroid flat normal. Vital sign normal auscultation lung moist ,Ht apex displaced to 6 intercostal and Lt.
No evidence on S3 or S4 however soft systolic murmur over the apex. JV destintion 3 cm above suprasternal notch, abd soft with tender hepatomegaly, pitting edema LL, UA with Cr 4.2 , BUN 88 and cellular cast.
Which of the following the cause of her cardiac decomposition and RF ?
a) Bulimic cardiomyopathy
b) Cocaine intoxication
c) Hypothyriodism
d) Myocardial ischemia
e) Myocarditis
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| guangyu
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A?
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| aspire
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Bulimic cardiomyopathy?
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| Jcala
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Is there such thing as a BULIMIC CARDIOMYIOPATHY ??
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| DrAlex_76
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yes , there is
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| Justice
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Jcala wrote:
Is there such thing as a BULIMIC CARDIOMYIOPATHY ??
Well, I am not aware of such nosology but cardiomyopathy may result from the long term abuse of ipecac...
Answer (E)
Edited by Justice on 04/07/08 - 07:44 PM
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| Justice
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J Adolesc Health. 2005 Sep;37(3):256-60.
Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status?
Silber TJ.
PURPOSE: To review and address the abuse of ipecac, describing its epidemiology, toxicity, clinical characteristics, and laboratory assessment. METHODS: A Medline search (1980-2003) for Ipecac abuse and Ipecac toxicity, n = 34. RESULTS: Ipecac abuse occurs predominantly among adolescent and young adult females who are either experimenting with purging or have an eating disorder. Psychiatric comorbidity is common. Death can occur and is usually of cardiac origin. Morbidity includes myocarditis with arrhythmias, myositis, gastroesophageal pathology, including Mallory Weiss tears, diarrhea, and metabolic abnormalities (alkalosis, hypokalemia, dehydration). The injuries can reverse with cessation of ipecac use. A high index of suspicion is needed for early detection. Classic findings are abnormal EKG and echocardiography and/or elevation of muscle enzymes (CPK, adolase). Emetine, the alkaloid in ipecac, can be confirmed in serum, urine, and tissue by high performance liquid chromatography. CONCLUSIONS: Ipecac abuse is dangerous, even deadly. However, if abuse is discontinued, cardiac and muscle damage tends to reverse. Were ipecac syrup to remain an over- the-counter medication, or become a prescription medication, more stringent warning labels ought to be included and further education be provided about its toxicity and potential for abuse. Removing ipecac from the over-the-counter category would best eliminate its potential for abuse.
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| peter90036
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 heh, nice find there Justice
what does this mean "PMx only for COC."
cause cardiac decomposition and RF ?
...decomposition?... ... ? " de-composition " ???
anyway...
cause for cardiac+renal failure
a) Bulimic cardiomyopathy
b) Cocaine intoxication ...says no hx drug use...maybe lying
c) Hypothyriodism --- from what symptoms???
d) Myocardial ischemia
e) Myocarditis
am i missing something ? is the question missing something ?
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| Jcala
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JUSTICE :
Your search for knowledge benefits us all.
keep up the good work !
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| aspire
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Justice makes sense..so is the right answer myocarditis?
Some one confirm please!
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| peter90036
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J will post answers tomorrow. keep your pants on everybody...
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