[23F] With chronic nausea, vomiting, weakness, and severe migraines
Patient Description
A 23-year-old female presents with chronic symptoms including significant weakness, constant nausea, and severe migraines. The weakness has been ongoing for a couple of years, rated 7 out of 10 in severity, and worsens with physical activity and heat exposure, often requiring the patient to lie down. The patient also experiences constant nausea for the past 4-5 years, with some relief from Ondansetron, and has been vomiting for over 10 years. In the past three days, the patient has vomited at least 25 times, unable to keep any food or liquids down, and has noticed blackish blood in the vomit resembling coffee grounds. Severe stomach cramps with a pain level of 7-8 out of 10 are also reported. The patient has a fluctuating appetite, sometimes eating large amounts and other times not eating for days, leading to significant weight loss. Frequent migraines are described as so severe that the patient cannot open her eyes, see light, hear anything, or move without vomiting. Additionally, the patient experiences vision blackouts and fuzziness every time she stands up. The patient has a history of severe anemia and depression, with feelings of self-hatred, lack of interest in activities, and constant sadness since the age of 7. Diagnosed with Celiac Disease about ten years ago, the patient did not take the diagnosis seriously. The patient experiences both constipation and occasional diarrhea, with constipation being more frequent. Diarrhea occurs every couple of months, with up to 7 bowel movements in a day, and the stool sometimes contains dark red streaks of blood. The patient has not traveled recently and has no other pre-existing conditions or chronic illnesses besides those mentioned. Currently, the patient is not taking any medications.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, there are several potential diagnoses to consider. Here are some possibilities:
Severe Anemia
- Explanation: Severe anemia can cause extreme fatigue, weakness, and dizziness, especially when standing up. It can also lead to shortness of breath and palpitations.
- Typical Treatments/Testing: Blood tests to check hemoglobin levels, iron studies, and possibly a bone marrow biopsy. Treatment may include iron supplements, dietary changes, or in severe cases, blood transfusions.
Celiac Disease
- Explanation: Celiac disease can cause chronic gastrointestinal symptoms like nausea, vomiting, diarrhea, and constipation. It can also lead to malabsorption of nutrients, contributing to anemia and weight loss.
- Typical Treatments/Testing: Blood tests for specific antibodies and an endoscopy with a biopsy of the small intestine. The primary treatment is a strict gluten-free diet.
Orthostatic Hypotension
- Explanation: This condition can cause your blood pressure to drop significantly when you stand up, leading to dizziness, blacking out, and almost fainting.
- Typical Treatments/Testing: Blood pressure monitoring, tilt-table test, and blood tests. Treatment may include increasing fluid and salt intake, wearing compression stockings, and medications to raise blood pressure.
Migraines
- Explanation: Migraines can cause severe headaches, nausea, vomiting, and sensitivity to light and sound.
- Typical Treatments/Testing: Diagnosis is usually clinical based on symptoms. Treatment may include medications to prevent migraines and relieve symptoms, lifestyle changes, and avoiding known triggers.
Gastrointestinal Bleeding
- Explanation: The presence of dark, coffee-ground-like vomit and dark red blood in your stool suggests gastrointestinal bleeding, which can be serious.
- Typical Treatments/Testing: Endoscopy, colonoscopy, and imaging studies to locate the source of bleeding. Treatment may include medications, endoscopic procedures to stop the bleeding, or surgery.
What you can do
Severe Weakness and Fatigue
- Seek medical attention immediately: Given the severity and duration of your symptoms, it's crucial to see a healthcare provider as soon as possible. They may perform blood tests and other diagnostic procedures to determine the cause.
- Rest and hydration: Ensure you are resting and staying hydrated, especially if you are experiencing vomiting and diarrhea.
Nausea and Vomiting
- Continue taking Ondansetron: As it helps with your nausea, continue taking it as prescribed.
- Small, frequent meals: Try eating small, bland meals and avoid foods that trigger your symptoms.
- Stay hydrated: Sip on clear fluids like water, broth, or oral rehydration solutions.
Migraines
- Avoid triggers: Identify and avoid triggers that may cause your migraines, such as certain foods, stress, or lack of sleep.
- Medications: Over-the-counter pain relievers or prescribed migraine medications can help manage your symptoms.
- Rest in a dark, quiet room: This can help alleviate the severity of your migraines.
Orthostatic Hypotension
- Stand up slowly: When getting up, do so slowly to give your body time to adjust.
- Increase fluid and salt intake: This can help maintain your blood pressure.
- Compression stockings: Wearing these can help improve blood flow and reduce symptoms.
Gastrointestinal Symptoms
- Seek medical attention: The presence of blood in your vomit and stool is concerning and requires immediate medical evaluation.
- Follow a gluten-free diet: If you have Celiac Disease, adhering to a strict gluten-free diet is essential to manage your symptoms and prevent complications.
What you should look out for
Given the severity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Persistent vomiting or inability to keep fluids down
- Severe abdominal pain
- Signs of dehydration (e.g., dry mouth, dark urine, dizziness)
- Fainting or near-fainting episodes
- Blood in vomit or stool
- Worsening weakness or fatigue
Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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5 mo ago