20 year old female patient presenting with:
* constant day to day Low Blood Sugar levels
* constant weak pulse and arrhythmia
* constantly below normal blood pressure
* random instances of isolated muscle pains that go away after a few days. (usually situated in the back, shoulders, arms and chest)
* random reoccurring instances where she will either just start feeling sick or actually be up all night throwing up. Usually feeling better by the next day.
* parent claims she is allergic to penasillin, paracetomol, codein because of reactions as a child (awaiting test results). Her sister was told the same but found not to be.
* poor appetite
* isolated instance of a burning rash on her hands - written off as allergic reaction. rash went away after a few hours. no known cause.
* last wednesday she complained about upper abdominal soreness and tenderness as well as nausea. by saturday was throwing up all night with severe upper abdominal pains. Doctor diagnosed her with a stomach ulser, treatment hasnt really been effective (now monday afternoon).
* according to parents struggled with asthma as a child
* in and out of hospital as a child for low BP, pulse and extremely shallow breathing.
* struggles with poor skin (scattered acne, possibly no related)
* extremely irregular to nonexistent menstrual cycle
* mother was on extremely potent fertility pills in order to fall pregnant with her. claims this may be the cause of all these irregularities
The problem with this case is that it is almost impossible to figure out which are genuine symptoms, which are just symptoms of symptoms, and if they are related to one single underlying problem or multiple problems. I have some ideas but none cover everything. What do you think?