A young lady complains of sudden onset of palpitations, extreme weakness and sweating. On examination, she was found to have B.P. 90/70 with a regular pulse rate of 180/minute. Her symptoms disappeared after vomitting but she complained of polyuria. The most likely diagnosis is
**Core Concept**
The clinical presentation described in the question suggests a case of a life-threatening electrolyte imbalance that affects the heart and nervous system. This condition is characterized by an excessive release of catecholamines, leading to a hyperadrenergic state.
**Why the Correct Answer is Right**
The sudden onset of palpitations, weakness, sweating, and hypertension (BP 90/70) in the presence of a high pulse rate (180/minute) is indicative of a severe hyperadrenergic state. The symptoms disappeared after vomiting, which suggests a relief of the symptoms due to gastric aspiration of the offending substance. The subsequent complaint of polyuria suggests an osmotic diuresis due to the presence of a hyperglycemic substance. The key to this diagnosis lies in the recognition of the substance that causes this constellation of symptoms. In this case, the likely substance is ethanol.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not explain the sudden onset of symptoms or the hyperadrenergic state. While certain medications can cause palpitations and weakness, they do not typically cause a high pulse rate or polyuria.
**Option B:** This option is incorrect because it does not explain the vomiting, which led to relief of symptoms. Additionally, while certain toxins can cause hyperglycemia, they do not typically cause a hyperadrenergic state.
**Option C:** This option is incorrect because it does not explain the high pulse rate or the hyperadrenergic state. While certain conditions can cause hypotension, they do not typically cause palpitations, weakness, or polyuria.
**Option D:** This option is incorrect because it does not explain the vomiting, which led to relief of symptoms. Additionally, while certain conditions can cause hyperglycemia, they do not typically cause a hyperadrenergic state.
**Clinical Pearl / High-Yield Fact**
When encountering a patient with a sudden onset of palpitations, weakness, and hypertension, consider the possibility of a hyperadrenergic state caused by an excessive release of catecholamines. Think of ethanol as a potential culprit, especially in patients who have recently ingested it or have a history of alcohol abuse.
**Correct Answer: C. Ethanol intoxication**