The Real-World Boards: Question #37
Worsening abdominal pain prompts a return trip to the ED
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A 64-year-old woman re-presents to the ED with persistent GI symptoms. She was seen four days prior with nausea, non-bloody diarrhea, and abdominal pain. A CT of her abdomen showed mild small-bowel wall thickening. Vitals were normal. After receiving IV fluids, she felt somewhat better and was discharged home from the ED.
She returns with worsening abdominal pain that is now severe, and diarrhea that is now bloody. She is febrile, with a pulse 110/min in new-onset atrial fibrillation, blood pressure 85/55, and respirations of 22/min.
She reports regularly taking aspirin-containing analgesics for the pain. Salicylate level is 35 mg/dL (upper limit of therapeutic level = 30 mg/dL).
On exam, her abdomen is soft with diffuse mild tenderness.
Labs show:
Nephrology are consulted. She receives 30 cc/kg of crystalloid resuscitation fluids.
