A patient presents with bradycardia, low serum sodium, a blood pressure of 86/54 mmHg, decreased level of consciousness, and difficulty breathing. His labs support severe hypothyroidism. Which life-threatening complication is he likely experiencing?

Choice A reason: Diarrhea is not a primary feature of acute pancreatitis. While gastrointestinal symptoms like nausea and vomiting occur due to pancreatic inflammation, diarrhea is less common. Pancreatitis typically causes reduced bowel motility from inflammation or ileus, leading to constipation rather than diarrhea, which is more associated with other conditions like gastroenteritis.

Choice B reason: Abdominal guarding is a classic sign of acute pancreatitis, as inflammation causes severe epigastric or left upper quadrant pain, leading to involuntary muscle tensing to protect the area. This response results from peritoneal irritation or pancreatic enzyme leakage, making it a key physical finding in assessing pancreatitis severity and guiding treatment.

Choice C reason: Hyperactive bowel sounds are not typical in acute pancreatitis. Inflammation often causes an ileus, leading to diminished or absent bowel sounds due to reduced gastrointestinal motility. Hyperactive sounds suggest conditions like bowel obstruction, not pancreatitis, where the inflammatory process slows peristalsis, making this finding inconsistent with the diagnosis.

Choice D reason: Ecchymosis in the flank (Grey Turner’s sign) is a hallmark of severe acute pancreatitis, indicating retroperitoneal hemorrhage from pancreatic enzyme leakage or necrosis. Blood tracks to the flank, causing bruising. This sign reflects significant disease severity, often requiring intensive care, and is a critical finding in pancreatitis assessment.

Choice E reason: Black, tarry stools (melena) indicate upper gastrointestinal bleeding, not typically associated with acute pancreatitis. While severe pancreatitis may rarely cause bleeding, melena is more common in conditions like peptic ulcers. Pancreatitis symptoms focus on pain, nausea, and bruising, not gastrointestinal bleeding, making this finding unlikely.

Choice F reason: Left upper quadrant pain radiating to the back is a classic symptom of acute pancreatitis. Pancreatic inflammation causes severe epigastric pain that often radiates to the back due to the pancreas’s retroperitoneal location. This pain pattern, often described as boring or constant, is a key diagnostic feature of pancreatitis.

Choice A reason: NSTEMI (non-ST-elevation myocardial infarction) is a heart attack caused by coronary artery occlusion, leading to myocardial ischemia. Symptoms include chest pain and elevated cardiac enzymes, not bradycardia, hyponatremia, or altered consciousness. Hypothyroidism does not directly cause NSTEMI, and these symptoms align with metabolic, not cardiac, pathology.

Choice B reason: Myxedema coma is a life-threatening complication of severe hypothyroidism, characterized by bradycardia, hyponatremia, hypotension, altered consciousness, and respiratory depression. Hypothyroidism slows metabolism, leading to fluid retention, low sodium, and reduced cardiac output. These symptoms match the patient’s presentation, making myxedema coma the most likely diagnosis in this scenario.

Choice C reason: SIADH causes hyponatremia due to excessive antidiuretic hormone, leading to water retention. However, it does not typically cause bradycardia, hypotension, or respiratory difficulty. SIADH is not a complication of hypothyroidism, and the patient’s symptoms, including altered consciousness, align more closely with myxedema coma than SIADH’s water imbalance.

Choice D reason: Thyroid storm is a life-threatening hyperthyroidism complication, presenting with tachycardia, hyperthermia, and agitation. The patient’s bradycardia, hypotension, and hyponatremia are opposite to thyroid storm’s hypermetabolic state. Hypothyroidism leads to myxedema coma, not thyroid storm, making this choice inconsistent with the patient’s clinical presentation and lab findings.