A 79 year old woman, a heterozygote for factor V
Leiden, had diffuse weakness. It started in the
summer of 2013. She was admitted in
September for proximal weakness of her upper
and lower extremities. She had difficulty holding
her head up. She used ski poles to walk. She
had fallen. She was dyspneic.
She had had pulmonary emboli. She takes
In the hospital, she had a CTA to rule out
recurrent emboli as the cause of her dyspnea.
Troponins were slightly elevated. A cardiology
consultant found no cardiologic cause for her
weakness. CK was normal. Anti-smooth muscle
antibodies were neg. She had a Klebsiella UTI,
and received antibiotics. She was discharged.
On December 4, she went to the POMH ER
because she could not swallow water. Physicians
ordered an antiAChR antibody and sent her to the
MMC ER, where she was admitted that evening.
Her magnesium was low at 1.4.
The medical student on her
case called for a Neurology
consult on December 5th.
He said she had diffuse
weakness and was
somewhat dyspneic. They
thought she had
myasthenia gravis. He said
an anti-AchR antibody test
had been ordered, but
results were pending.
The NIF returned at
-10. She was
transferred to the ICU,
under the care of the
ABGs, on 3 L, were
pH 7.26, pCO2 56, pO2
136. She was put on a