BOF: 122
A 57-year-old male presents with an acute confusional
state. This was preceded by a few days of headache, nausea and vomiting and
visual disturbance. His GP had been treating him with an antihistamine as he
had complained of itching over the last few months. The GP had also treated
him a few weeks earlier for a swollen, hot, painful joint. He had prescribed
NSAIDS and antibiotics.
On examination he was overweight, he looked plethoric,
and cyanosed. There was no
clubbing. No murmurs, lungs clear. Liver was enlarged 3 fingerbreadths and the
spleen was enlarged about 5 fingerbreadths.
No focal neurological signs. On examination of the optic fundus engorged veins were seen.
Investigations:
Hb 22.4 g/dl
MCV 73 fl
WBC 20.3
Na 138 mmol/l
K 3.8 mmol/l
Urea 5.6 mmol/l
Creatinine 90 micromoles/l
Chloride 97 mmol/l
Bicarbonate 30 mmol/l
Calcium 2.32 Albumin 37 g/l
Phosphate 1.09 mmol/l
ESR 1 mm/1st hour
In this patient your course of action should be:
a)
Blood gas analysis followed by oxygen therapy
b)
Bone marrow examination
c)
Venesection
d)
Blood cultures followed by broad spectrum antibiotics until cultures
are available
e)
CT scan and lumbar puncture
Answer:
c)
This patient has polycythaemia rubra vera. He has
pruritus, gout and he has presented with a hyperviscosity syndrome.
The immediate management should be venesection and appropriate fluid
replacement
Revision Tip
Revise PRV and secondary polycythaemia
KEYS to SUCCESS in Medicine page 386-388
