4. A Midlife Crisis

  1. James C. Pile6,
  2. Thomas E. Baudendistel7 and
  3. Brian J. Harte8
  1. Jennifer R. Lukela1,
  2. Rajesh S. Mangrulkar1,
  3. Lawrence M. Tierney2,
  4. John Del Valle1 and
  5. Sanjay Saint1,3,4,5

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch4

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Lukela, J. R., Mangrulkar, R. S., Tierney, L. M., Del Valle, J. and Saint, S. (2013) A Midlife Crisis, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch4

Editor Information

  1. 6

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 7

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 8

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

  2. 2

    Department of Medicine, University of California, San Francisco, California, USA

  3. 3

    Ann Arbor VA Health Services Research and Development Field Program, Ann Arbor, Michigan, USA

  4. 4

    Patient Safety Enhancement Program, University of Michigan Health System, Ann Arbor, Michigan, USA

  5. 5

    Tuscan-American Safety Collaborative, Florence, Italy

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206



  • abdominal pain;
  • atrial flutter;
  • diagnoses;
  • hypercalcemia;
  • tachycardia;
  • thyrotoxicosis


The case study explained in this chapter highlights the importance of using all the clinical clues provided by the history, physical exam, and laboratory and imaging studies when generating an initial differential diagnosis, as well as the importance of being willing to appropriately broaden and narrow the list of possibilities as a case evolves. This case illustrates the importance of constantly reevaluating the available information from physical examination and laboratory and imaging studies and not falling victim to “intellectual blind spots” created by suggested diagnoses by other care providers. A regular narrow-complex tachycardia of approximately 150 beats per minute should always prompt consideration of the possibility of atrial flutter. A variety of “nonsurgical” conditions may cause diffuse abdominal pain and should be considered in the appropriate setting. These include thyrotoxicosis, hypercalcemia, acute intermittent porphyria, lead intoxication, familial Mediterranean fever, adrenal insufficiency, diabetic ketoacidosis, and vasculitis.