A 55-year-old woman, with a previous history

A 55-year-old woman, with a previous history of breast cancer, presented to her physician complaining of shortness of breath, headaches, and heartburn. Following the physical exam, lab work was ordered, and the patient was given a diagnosis of asthma and reflux. She received medications for both conditions. Over the next few months, her congestion worsened, and she returned to the ER, complaining of headaches and asthma. An x-ray showed fullness in the left ethmoid. Labs were drawn but not recorded or commented on, and there was no record of lab results from the bloodwork done in the physician’s office. The ER physician prescribed antibiotics for a sinus infection and told her to continue to use her inhalants. 11 days later she collapsed and was rushed to the ER. She was “ruled out” for MI. As for other tests, head CT = negative, Na = 121, and chest CT was abnormal. The ER physician requested records of previous lab work and noticed that six months previously, the patient’s Na=140. The chest x-ray = bone metastases; CT chest = pulmonary mass and extensive adenopathy, consistent with cancer. Identify the basic topic of this case. What are the issues in this case? What are the key learning points? What clinical guides or care processes could be suggested? Where is there room for improvement? If you encountered this case, what would you do?

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