Case Report

Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis

Table 1

Second hospitalization (6 days after shoulder manipulation).

Day 1 of 2nd hospitalizationNight 1 of 2nd hospitalizationDay 2 of 2nd hospitalizationDay 4 of 2nd hospitalization

Respiratory rate20–32 breaths/minute13–40 breaths/minute40 breaths/minute
Oxygen saturation97% on 3 liters of oxygen 88% on room air92–96% on 2 liters of oxygen93% on room air
Heart rate66 beats/minute65–75 beats/minute85–95 beats/minute
Blood pressure135/95130/80
White blood cell count (normal range 4,500–10,000 cells/μL)18,000 cells/μL16,200 cells/μL11,600 cells/μL10,400 cells/μL
TemperatureAfebrileAfebrileAfebrileAfebrile
Hematocrit, hemoglobin, red blood cell count, plateletsAll Within Normal Limits
Comprehensive metabolic panel (glucose, calcium, albumin, total protein, sodium, potassium, chloride, BUN, creatinine, AST, ALT, ALP, bilirubin)All Within Normal Limits
Creatine kinase (CK) (normal range 96–140 units/L)330 units/L147 units/L
CKMB (normal range 0.0–5.0 ng/mL) 0.9 ng/mL1.3 ng/mL
CK index (normal range 0.3–0.9%)0.30%0.90%
Troponin (normal range 0.3–2.0 ng/mL)0.3 ng/mL
D-Dimer (normal range 68–494 ng/mL)1256 ng/mL
Fibrinogen (normal range 148–413 mg/dL)499 mg/dL
pH (normal 7.35–7.45)7.58
pCO2 (normal range 35–45 mmHg)23 mmHg
pO2 (normal range 80–100 mmHg)85 mmHg
Bicarbonate (normal range 19–25 mEq/L)20.8 mEq/L
Base excess (normal range −2.5–2.5 mEq/L)1.1 mEq/L
Lactic acid (normal range 0.7–2.1 mmol/L)2.0 mmol/L
Erythrocyte sedimentation rate (normal range 0–20)36