TY - CHAP M1 - Book, Section TI - Endocrine Disorders in Critical Illness A1 - Lee, Kiwon A2 - Lee, Kiwon Y1 - 2012 N1 - T2 - The NeuroICU Book AB - A 42-year-old woman with past medical history of hyperthyroidism who had radioactive iodine treatment 2 years prior now presents to the emergency department with high fever, sweating, and confusion. These symptoms were preceded by coughing, sore throat, and body aches for 3 days. Shortly after arriving at the hospital, the patient started to have a partial-onset seizure with secondary generalization leading to generalized tonic-clonic jerks for a duration of 30 seconds followed by a period of postictal confusion. Two hours later, the patient is admitted to the neurologic intensive care unit (ICU) with a working diagnosis of "rule out status epilepticus" and is being hooked up to continuous electroencephalography. The initial vital signs are as follows: blood pressure (BP) 190/104 mm Hg, heart rate (HR) 105 to 110 beats per minute (bpm) in sinus rhythm, temperature 38.8°C (102°F), and o2 saturation 98% in room air. On examination, the patient's eyes are closed and she is arousable to nonpainful tactile stimulation; she is lethargic and diaphoretic, with hyperpyrexia, sinus tachycardia, tachypnea, mild resting tremors, and delirium. The patient's family reports normal diet and adequate hydration up until she started feeling ill this morning. While being examined, the patient develops a narrow QRS-complex supraventricular tachycardia with HR of 120 bpm, which subsided with an intravenous (IV) esmolol drip at 50 μg/kg per minute, which was given without the typical 0.5 mg/kg loading dose.Given this patient's past medical history significant for hyperthyroidism, a working diagnosis of thyroid storm is made, which was believed to be triggered by an upper respiratory viral infection. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - neurology.mhmedical.com/content.aspx?aid=1101646083 ER -