Case of the Week
A 72-year-old woman with a history of COPD, hypertension, and chronic constipation
arrives to the ED after feeling weak and dizzy earlier today when standing from
a sitting position.  She denies preceding or subsequent chest pain; shortness of breath; nausea; head, back, or abdominal pain.  There is no history of trauma and she has had no recent changes to her medications.  On review of systems, over the past few months she has had generalized weakness and family reports her slow progression of having less energy, needing more time to get dressed, and becoming easily confused and fatigued.  They are concerned that they can no longer care for her at home.

On examination, our patient’s vital signs are: T 97.0 °F HR 66 BP 118/70 RR 12 SpO2 96% RA.  In general, she is slow to respond but attends well to questioning; her
voice is coarse, which her family attributes to her previous smoking history.  Her cardiovascular and pulmonary exams are unremarkable.  Total body check shows no evidence of trauma, infection, or toxidrome; her skin is dry and flaky, but with normal turgor.  Her electrocardiogram, chest x-ray, metabolic panel, and urinalysis are
all inconclusive.  She remains hemodynamically stable in the ED.

Which is the next BEST step in her management?

    A. Admit her for observation and likely placement
    B. Stop all medications and admit for medication washout
    C. Discharge home with follow up and likely placement as outpatient
    D. Admit for likely hormone replacement therapy

In the meantime, a quote – 

"Old age hath yet his honour and his toil." 

– Alfred Lord Tennyson (1809-1892)


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