North Carolina – Internal Medicine – Oral Lesions, Odynodysphagia, Weight Loss, And Poor Appetite

On March 2007, a patient with a history of diabetes, hypertension, and hyperlipidemia presented to a primary care physician who was board certified in internal medicine and nephrology for management of his medical issues.

On 07/16/2013, the patient presented to the nephrologist with oral lesions and painful swallowing.  The patient was on lisinopril, clonidine, triamterene/hydrochlorothiazide, and metformin.  The patient was diagnosed as having oral and possibly esophageal candidiasis.  The patient was initiated on clotrimazole and fluconazole.  The patient returned the next week with poor appetite and weight loss.

Labs were not reviewed by the nephrologist until two days later.  They revealed elevation of BUN, creatinine, and potassium as well as a low TSH.  The nephrologist requested the patient present to the hospital.

When the patient arrived to the emergency department, she was told she required transfer to another hospital for treatment.  While en route, the patient coded.  She stayed on life support for nine days before passing away secondary to acute renal failure and thyroid storm.

The Board expressed concern that the nephrologist’s conduct was below the minimum standard of competence.  They noticed disorganized documentation and missing information along with failure to obtain an adequate history and failing to document relevant physical findings.

The Board issued a public letter of concern and reported the letter to the Federation of State Medical Boards.

State: North Carolina

Date: January 2015

Specialty: Internal Medicine, Emergency Medicine, Endocrinology, Family Medicine, Internal Medicine, Nephrology

Symptom: Weakness/Fatigue, GI Symptoms (GERD, Abdominal Distention, Dysphagia)

Diagnosis: Endocrine Disease, Renal Disease

Medical Error: Failure to follow up, Delay in proper treatment, Referral failure to hospital or specialist

Significant Outcome: Death

Case Rating: 3

Link to Original Case File: Download PDF

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