[39F] With severe dizziness, diarrhea, and chest pain

Patient Description

A 39-year-old female presents with severe dizziness, diarrhea, and chest pain. The diarrhea has been ongoing for the past 24 hours, starting as light-colored and chunky and progressing to completely watery and very loose. She has had two watery bowel movements in the past 24 hours. There is no specific food trigger, no recent travel, and no blood in the stool, although the last one appeared darkish brown with a possible reddish tint. She has been feeling dizzy all the time, with severe dizziness today, described as lightheadedness with occasional black or colored spots. She has been experiencing significant fatigue and weakness for a couple of weeks, rated as 6 out of 10 in severity, which has severely affected her daily activities. She also reports irritability, brain fog, and impaired cognition. The patient has sharp chest pain that goes away with deep breaths and calming herself, rated as 6 out of 10. She has had headaches for the past 4-6 months, located on her forehead, temples, and sometimes all over her head, with varying intensity from dull to sharp. She has had a low-grade fever and chills for the past two days and has not been able to keep any food or fluids down since yesterday, with changes in urine output. Her past medical history includes anemia diagnosed in 2002, significant blood loss during her last childbirth requiring a blood transfusion, a partial hysterectomy, and surgery for endometriosis and adhesions. She is currently taking Suboxone (8mg strips, three times a day) and sometimes uses BC powders or Tylenol. She has no known allergies to medications. She was diagnosed with bipolar disorder, manic-depressive disorder, depression, and anxiety, and was prescribed Raylar and lithium but did not continue with the medications due to side effects.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, several potential diagnoses could explain your condition. Here are the most likely ones:

1. Gastroenteritis

  • Rationale: Your sudden onset of diarrhea, abdominal pain, and inability to keep fluids down are classic symptoms of gastroenteritis, which is an inflammation of the stomach and intestines. This can be caused by viral, bacterial, or parasitic infections.
  • Typical Treatments/Testing: Treatment usually involves staying hydrated, rest, and sometimes medications to control symptoms. In severe cases, IV fluids may be necessary. Stool tests can help identify the specific cause.

2. Dehydration

  • Rationale: Given your inability to keep fluids down and the frequency of diarrhea, dehydration is a significant concern. Symptoms like dizziness, weakness, and dark urine are common in dehydration.
  • Typical Treatments/Testing: Rehydration is key, either orally or through IV fluids. Blood tests can assess the severity of dehydration and electrolyte imbalances.

3. Anemia

  • Rationale: Your history of anemia and symptoms like fatigue, weakness, and dizziness could indicate that your anemia has worsened or recurred.
  • Typical Treatments/Testing: Blood tests to check hemoglobin levels and iron studies. Treatment may involve iron supplements or other medications.

4. Cardiac Issues

  • Rationale: Your chest pain, rapid heart rate, and feeling of your heart not beating right could indicate a cardiac issue, such as arrhythmia or other heart conditions.
  • Typical Treatments/Testing: An ECG, blood tests, and possibly a referral to a cardiologist for further evaluation.

5. Mental Health Conditions

  • Rationale: Your history of bipolar disorder, depression, and anxiety, along with symptoms like irritability, brain fog, and severe headaches, suggest that your mental health conditions may be contributing to your overall feeling of unwellness.
  • Typical Treatments/Testing: Consultation with a mental health professional for medication management and therapy.

What you can do

Immediate Steps

  1. Hydration: Try to sip small amounts of water or an oral rehydration solution frequently. Avoid large amounts at once, which might worsen your diarrhea.
  2. Rest: Rest as much as possible to help your body recover.
  3. Seek Medical Attention: Given the severity of your symptoms, especially the chest pain and inability to keep fluids down, you should seek medical attention as soon as possible. Go to the emergency department if necessary.

Managing Symptoms at Home

  1. For Diarrhea and Abdominal Pain:

    • Avoid solid foods for a few hours and then gradually reintroduce bland foods like bananas, rice, applesauce, and toast (the BRAT diet).
    • Avoid dairy, caffeine, alcohol, and fatty or spicy foods.
    • Use over-the-counter anti-diarrheal medications like loperamide (Imodium) if recommended by a healthcare provider.
  2. For Dizziness and Weakness:

    • Sit or lie down immediately if you feel dizzy to prevent falls.
    • Avoid sudden movements and get up slowly from sitting or lying positions.
  3. For Headaches:

    • Use over-the-counter pain relievers like Tylenol (acetaminophen) or ibuprofen, but avoid overuse.
    • Rest in a dark, quiet room and apply a cool compress to your forehead.
  4. For Chest Pain:

    • Practice deep breathing exercises to help calm yourself.
    • Avoid strenuous activities until you have been evaluated by a healthcare provider.

Long-Term Management

  • Track Symptoms: Use MDandMe to journal your symptoms, track progress, and get insights. This can help you and your healthcare provider understand your condition better.
  • Follow-Up: Schedule follow-up appointments with your healthcare providers to address ongoing issues like anemia, mental health conditions, and any new symptoms.

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 or worsening chest pain
  • Severe dehydration symptoms like not urinating, very dark urine, or feeling faint
  • Severe abdominal pain or blood in your stool
  • Severe headache or changes in vision
  • Any new or worsening symptoms

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. Take care, Ashley.

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5 mo ago

People Also Ask


What are the common causes of severe dizziness and how can it be managed?

Severe dizziness can be caused by dehydration, low blood pressure, anemia, or inner ear issues. Management includes staying hydrated, sitting or lying down when dizzy, and avoiding sudden movements. If dizziness persists, medical evaluation is necessary.


How can dehydration be identified and treated effectively at home?

Dehydration can be identified by symptoms like dry mouth, dark urine, dizziness, and fatigue. It can be treated at home by drinking small, frequent sips of water or oral rehydration solutions. Severe dehydration may require medical attention and IV fluids.


What are the potential causes of chest pain and when should it be considered an emergency?

Chest pain can be caused by heart issues, muscle strain, or anxiety. It should be considered an emergency if it is severe, persistent, or accompanied by symptoms like shortness of breath, sweating, or nausea. Immediate medical evaluation is recommended in such cases.


How can mental health conditions like bipolar disorder and anxiety contribute to physical symptoms?

Mental health conditions can lead to physical symptoms like fatigue, headaches, and chest pain due to stress and anxiety. They can also affect sleep and energy levels. Managing these conditions with therapy and medication can help alleviate physical symptoms.


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