[27F] Experiencing intermittent episodes of blurred vision and faintness
Patient Description
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Arora's Assessment
Blurred vision and lightheadedness
Differential diagnosis
- Given the sudden onset of symptoms and their resolution with candy and water, hypoglycemia (E16.2) is a likely diagnosis.
- Other possibilities include panic attack (F41.0), vasovagal syncope (R55), and postural orthostatic tachycardia syndrome (I49.8).
- Less likely but still possible are transient ischemic attack (G45.9), and migraine with aura (G43.1).
Plan
Order a fasting glucose test and a glucose tolerance test to evaluate for hypoglycemia. Also, consider ordering a complete blood count (CBC), electrolyte panel, and thyroid function tests to rule out other potential causes of her symptoms. If these tests are inconclusive, consider referral to a neurologist or endocrinologist for further evaluation.
Advise the patient to maintain regular meals to avoid hypoglycemia, and to continue to consume candy or a sugary drink if she feels an episode coming on. If the episodes continue or increase in frequency, consider a trial of a beta-blocker or selective serotonin reuptake inhibitor (SSRI), which can help manage symptoms of panic attacks and postural orthostatic tachycardia syndrome.
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11 mo ago