The woman comes with a pre-existing diagnosis in the hospital: it suffers from the so-called cyclic vomiting syndrome. Phase way, plague you severe Nausea and to vomit often. As a hospital in the US state of Massachusetts goes to 39-Year-old, she has, in addition, diarrhea, and suffers from pain in the lower right abdominal area. She currently has her days.

The Doctors carry out some Tests to discover without a cause for complaints. In blood and stool, no sign of pathogens are found. A urine test is positive for cocaine and opiates. A computer tomography (CT) shows kidney stones, the clog but neither renal gears even ureter. There are no signs of inflammation in the abdominal cavity or the abdomen are to be found. The ovaries look normal and healthy.

The patient receives medication to alleviate nausea and pain. Already on the following day she was well enough to leave the hospital again.

She feels weak and has a fever

Eleven weeks later, the woman breathing in case of fire, the smoke. Shortly thereafter, she developed pain in the lower left abdominal area and is very exhausted. With these complaints, however, goes not to the doctor.

On the following day, their rule begins. Wake up sick and you have to throw up. In the next twelve hours she vomits again and again. You feel weak, you feel dizzy and she has a fever of 39.4 degrees Celsius. Finally, she seeks out the emergency room of the Massachusetts General Hospital in Boston.

Your temperature is now down and is 37.2 degrees. Your heart beats very quickly: 165 Times a Minute. As your breathing is increased with 22 breaths per Minute. She speaks very quickly, partly indistinct. The woman appears to the Doctors very uneasy. Your hands are shaking slightly, her face and upper body flushed and warm. When listening to the heart a heart is noticeable noise, which indicates a Problem.

Another important Detail is the Doctors call, in their case report in the “New England Journal of Medicine”: The woman weighs in at only 52,5 kg; when staying in the hospital eleven weeks ago, her weight was 59.3 per Kilo.

You have, in the past, various drugs – cocaine, Heroin, marijuana and Ecstasy. Recently, they have consumed only marijuana, she says.

In the clinic you must pass again

Not half an hour after their arrival in the emergency room, the 39-Year-old must hand over again. Your pulse rate increases from 165 to 210.

The Doctors monitor immediately by ECG on your heart. They observed that the patient has a so – called super-AVENT rikuläre tachycardia a tachycardia originating above the ventricles, such as in the Atria. You administer the woman of adenosine to terminate this rhythm disturbance of the heart. The heartbeat changes, grid however, more – now in the Form of a so-called sinus tachycardia.

In the blood the amount of certain liver enzymes that of the Aesir so-called alkaline phosphate is increased. Besides, the woman has not consumed according to the Test, only marijuana, but also the opioids Fentanyl and oxycodone.

A CT shows no problems of the lungs and heart. It confirmed the eleven weeks past diagnosis: The wife has kidney stones, which block, however, no vessels. The bowel is inflamed or blocked, the Appendix appears normal.

The patient is brought to the intensive care unit, where she receives intravenous fluid, and your sedative and a drug to prevent Nausea may be administered.

What brought the heart to the lawn?

In order to explore what underlies the complaints, go through the Doctors first of all, the possible causes of sinus tachycardia. To do this, especially pain, infection, bleeding, and a decreased amount of blood to count.

Although the patient of pain reported, but it appears the medical community is unlikely that these have caused the pronounced tachycardia. Because other signs of infection are missing, exclude this as a cause. A loss of volume due to persistent vomiting, it is conceivable, however, the blood values are not changed accordingly. A larger blood loss is not suffered by the wife. Some of the obvious causes of divorce thus.

A diagnosis that explains all the symptoms

The team of Doctors headed by Victor Chiappa consider, therefore, what all of the other symptoms – vomiting, pain, fever, weight loss, anxiety could explain.

• You may have opioid withdrawal symptoms? Then you would have to actually have other symptoms, such as dilated pupils.
• That the woman has lost a lot of weight, restless and sometimes slurred talking, could indicate an ovarian tumor. The tachycardia could not explain. A CT image of pelvis shows nothing.
• Hyperthyroidism could turf the heart and the weight loss of the patient explain. The other symptoms could be due to an Excess of thyroid hormones explain.

Several Tests not only confirm the latter suspicion, but show in addition that the patient is at the so-called Crohn’s suffers from graves’. This auto-immune disease the body’s immune system stimulates the increased production of thyroid hormones.

The patient, a so-called thyrotoxic crisis is caused by the Excess of thyroid hormones a life-threatening condition. This is manifested by tachycardia, vomiting, diarrhea, redness of the skin, restlessness, and increased temperature: all symptoms observed by the Doctors at the patient.

Four, five days, after taking various drugs, she’s already much better. After being discharged from the hospital, she goes for further treatment to a specialist. Unfortunately, Tests show a few months later, that she takes her medication as recommended. Finally, it does not show up at the doctors, the clinic doctors.