OVERVIEW ABOUT PATIENT:

SALT CRAVINGS, LOW BLOOD PRESSURE, HYPER-PIGMENTED PALM CREASES, HYPONATREMIA, HYPERKALEMIA, HYPOGLYCEMIA

CHIEF COMPLAINTS:

A patient comes in to their primary care office. They tell you that yesterday they had a near syncopal event. They do recall feeling lightheaded and dizzy. They deny any history of seizures, strokes, myocardial infarction, and/or any other neurological/cardiac history. They also deny any family history of any of these issues. They tell you that “I feel like my blood pressure is low lately”. They also tell you that they have been eating a lot of salty foods like peanuts and chips.

REVIEW OF SYSTEMS:

GENERAL: They deny any recent fevers or chills. They report weight loss over the last 3 months but they don’t know exactly how much. They also complain about feeling extremely fatigued.

CARDIOVASCULAR: Denies any chest pain, palpitations, or extremity swelling. They do have periodic dizziness but never have a fall or full syncopal event

RESP: Denies any coughing, wheezing or shortness of air

GI: They have had some nausea and vomiting, but denies any abdomen pain or diarrhea

INTEGUMENT: They tell you “I have also had some weird darkening on my hands over the last few months.” They deny any rashes, ulcers, or itching

NEURO: They deny any confusion, forgetfulness, numbness or tingling

PSYCHE: They deny any hallucinations, agitation or anxiety

PHYSICAL EXAM:

VITALS: are checked: 92/55, R 16, Temp 98, Pulse ox 96%

CARDIOVASCULAR: RRR, no murmurs, no pedal edema, no JVD

GI: BS + in all 4 quadrants, no abdomen tenderness

MUSCULOSKELETAL: Full ROM, no joint effusion or swelling, Patellar reflexes 2+

INTEGUMENT: Areas of hyper-pigmentation noted especially in their palmar creases. No rashes, ulcers, petechiae, or ecchymosis

NEURO: PERRLA, equal grips, Cranial Nerves 2-12 intact

LABS:

Chemistry:

Sodium (Na)- 129

Calcium (Ca)-10.3

Potassium (K)- 5.5

Glucose- 68

CBC:

All within normal limits[/vc_column_text]