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April 24, 2024

You are taking care of a 48-year-old female who presents to the Emergency Department and states “my is heart pounding”.

You are taking care of a 48-year-old female who presents to the Emergency Department and states “my is heart pounding”. She reports her hands are shaky and she is sweaty. She also complains of being exhausted and easily fatigued. She has had an unexplained 20 lb. pound weight loss in the last 3 months. She was laid off from her teaching job 4 months ago and has been worried about her finances. Her family history includes her mother with ulcerative colitis and her sister with celiac disease. Past surgical/ medical history: Tonsillectomy age 5, Pernicious anemia Medications: Vitamin B12 100mcg IM monthly

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