Cotton Mouth In A Cross Country Runner.

Abstract

HISTORY: A 21-year-old Division I cross-country runner presented to the athletic training room the day he was to leave for ACC championships, concerned about his intolerable dry mouth, leg heaviness and worsening fatigue. He had an unintended weight loss of 15 pounds despite working with Sports Nutrition over the summer due to a baseline BMI of 17.9 and a history of a sacral stress fracture the prior year. He endorsed normal eating pattern, but often felt full secondary to increased fluid intake from his dry mouth. Over the past few days, he also noted the onset of blurry vision. His only medication was an Omega-3 supplement and he denied a family history of autoimmune diseases, but did have an uncle with Type II diabetes mellitus. PHYSICAL EXAMINATION: Temp: 36.9 °C (Oral) HR: 54 beats per minute Orthostatic blood pressure: Supine: 112/72 Standing: 108/65 Weight: 61.3 kg BMI: 17.36 kg/m2 GEN: No acute distress, Thin. Cachectic appearing. HEENT: Eyes prominent where conjunctiva is visible around entire iris, no thyromegaly. Tongue and uvula covered with white scrapable film, no cervical lymphadenopathy. CV: Normal S1, S2, normal rhythm. No murmurs. Bradycardic (baseline for patient). NEURO: Alert, oriented x3, speech fluent, sensation intact. PSYCH: Quiet, slower to respond compared to baseline. “Spacey,” but logical thinking. No tangentiality. DIFFERENTIAL DIAGNOSIS: Relative energy deficiency in sport Overtraining syndrome Thyroid disease Anemia Viral illness/ Mononoculeosis Diabetes Mellitus Type 1 Malignancy Diabetes Insipidus TEST AND RESULTS: Urinalysis: Color yellow, Appearance Clear, Specific Gravity 1.035, pH 6.5, Protein Neg., Glucose 3+, Ketone Moderate, Bilirubin Neg., Blood Neg., Nitrite Neg., Leukocyte esterase neg. CBC: WBC 7.3, Hgb. 16.6, Hct. 46, Plt. 268 CMP: Na 130, K+ 5.6, Cl. 88, Bicarb. 27, BUN. 39, Cr. 0.8, Glc. 870, Alk phos. 183, ALT 67, AST 35, Anion Gap 15 TSH 0.27, Free T4 0.9, Free T3 1.5 CRP 0.2 ESR 7 Ferritin 224 HIV Non-reactive Hgb. A1c 13.6 FINAL WORKING DIAGNOSIS: New onset Diabetes Mellitus Type 1 in diabetic ketoacidosis TREATMENT AND OUTCOMES: Urgent transport to the emergency department for DKA management including insulin and intravenous fluids with several day admission. Endocrinology work-up in process. Plan to follow weekly x 6 weeks and held from sport the remainder of the semester.