A patient presents to the emergency department (ED) with the following clinical signs:
Pulse: 132 beats/min
Blood pressure: 88/50 mm Hg
Respiratory rate: 32 breaths/min
Temperature: 104.8° F
Chest x-ray: Findings consistent with congestive heart failure
Cardiac rhythm: Atrial fibrillation with rapid ventricular response
These signs are consistent with which disorder?
a. Adrenal crisis
b. Myxedema coma
c. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
d. Thyroid storm
D
Tachycardia, vascular collapse, rapid cardiac rhythms, congestive heart failure, and severe hyperthermia are consistent with the clinical manifestations of the hypermetabolic state of thyroid storm. Adrenal insufficiency presents with weakness, fatigue, weight loss, anorexia, abdominal pain, and hyperpigmentation. Myxedema coma is an extreme form of hypothyroidism and is characterized by signs of hypometabolism, including bradycardia, hypotension, hypothermia, cold intolerance, and neurological sluggishness. SIADH is characterized by fluid retention, hyponatremia, and hemodilution. Heat intolerance and atrial fibrillation are not typical characteristics of the condition.
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