JIST

Abstract

Patients with vague complaints with multisystem involvement often present to the Emergency department (ED). Once routine differential diagnoses are ruled out, the rarer differentials although suspected, cannot be confirmed in the ED. Following up patients after admission could improve the diagnostic skills and knowledge of Emergency physicians (EPs), as well as the internist. A middle aged man presented with “twisting” sensation in the abdomen, vomiting , numbness of both hands and difficulty in articulation. Later he developed ventricular bigeminy. All routine investigations and imaging studies were normal. He was taking Indian Herbal medication for alcohol de-addiction. As a definitive diagnosis could not be arrived at, he was admitted for monitoring. Retrospectively, a differential diagnosis of heavy metal poisoning was considered by the EP. The laboratory result was positive for lead. Obstacles faced by the EP were diagnostic challenges in the chaotic ED, to logistic challenges in following the patient up and sending samples in cold storage, to a laboratory several hundred kilometres away.