JFarnsworth Posted September 3, 2010 Share Posted September 3, 2010 I had a patient come in today for a salty taste in his mouth X 2-3 years. It's intermittent, he cannot think of anything that exacerbates it, or anything that makes it worse/better. He has tried cutting out all salt (no relief), and currently is trying to lose weight by eating more salad and chicken, and bypassing the local Micky D's. His last dental cleaning was 2 months ago (although his teeth still look a little grungy). He has a bridge in his mouth and only one porcelain filling, that's it. He is not on any meds, has no allergies, denies post nasal drip, and does not think he has been exposed to any toxic chemicals (he works in construction). He is generally healthy except he smokes 2 packs a day. He had a series of labs (chem panel, CBC, cholesterol, TSH/free T4, LFTs) and it all came back normal. He rarely drinks alcohol. His HEENT exam was normal. He has no LAD, his salivary glands are not enlarged or painful, chest is clear. Other than an MRI of his brain or an ENT referral, any ideas? I was thinking of testing him for heavy metal exposure. But basically, I'm at a loss.:sweat: Link to comment Share on other sites More sharing options...
TXPA23 Posted September 3, 2010 Share Posted September 3, 2010 has there been any trauma? salty taste in mouth and complaints of thin nasal secretions are classic presentations of CSF leak. I would get an MRI. Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 3, 2010 Author Share Posted September 3, 2010 Thanks TXPA23... he denied any trauma or known cause for the taste. Since he's had it for 2-3 years, is it possible for him to have a CSF leak that long? My SP thought there might be a problem with his kidneys, but his BUN and creatinine are normal. Link to comment Share on other sites More sharing options...
Evan Posted September 3, 2010 Share Posted September 3, 2010 Is he on any meds or supplements? Something that he only takes every so often? I thought heavy metal exposure only caused hearing loss... ha ha ha! I crack me up...sorry, couldn't resist... Link to comment Share on other sites More sharing options...
Leeg Posted September 3, 2010 Share Posted September 3, 2010 If he was craving salt I would think adrenal glands. I wonder if it could still be overactive / underactive adrenal gland? Link to comment Share on other sites More sharing options...
TXPA23 Posted September 3, 2010 Share Posted September 3, 2010 Thanks TXPA23... he denied any trauma or known cause for the taste. Since he's had it for 2-3 years, is it possible for him to have a CSF leak that long? My SP thought there might be a problem with his kidneys, but his BUN and creatinine are normal. I actually saw a mystery diagnosis on the discovery health channel where the patient was c/o salty taste for years before someone figured out that it was a slow csf leak. I have only seen it in trauma patients and tumor resection patients...But I have seen, and i know you have too, tons of pts with renal issues and none have ever c/o salty taste in their mouth. Link to comment Share on other sites More sharing options...
Shawn_Not_Sean Posted September 3, 2010 Share Posted September 3, 2010 I thought I remember learning about a patient once that had a like small hole that was leaking CSF fluid really slowly, that wasn't trauma or tumor related?... It might have been that Mystery Diagnosis episode, actually. Haha. Love that show. The way the OP stated it, it didn't sound like to me that patient wasn't craving salt as much as he was having a salty taste in his mouth. To me those are different things that need clarifying. Link to comment Share on other sites More sharing options...
roman6163 Posted September 4, 2010 Share Posted September 4, 2010 His last name isn't Lewinski, is it? Link to comment Share on other sites More sharing options...
armymedic>PA Posted September 4, 2010 Share Posted September 4, 2010 Taste Hallucination? Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 4, 2010 Author Share Posted September 4, 2010 Is he on any meds or supplements? Something that he only takes every so often? I thought heavy metal exposure only caused hearing loss... ha ha ha! I crack me up...sorry, couldn't resist... Clever, young Jedi. I am reaching with the heavy metal tests. Evan, he is not taking any meds. He takes a multivitamin every day. Leeg: he does not crave salt. He said he liked a lot of salt but has cut back and it didn't change his symptoms. A slow CSF leak could do it... I will have to try to convince him to pony up the $$$ for an MRI (he has no insurance--- of course). Roman: boooooooooooooo that was soooooooo wrong. Funny, but wrong. And sometimes "it" isn't salty, sometimes "it" is sweet. I heard eating lots of pineapples does that. Don't ask me how I know this. Link to comment Share on other sites More sharing options...
freetv4me Posted September 7, 2010 Share Posted September 7, 2010 Have you thought about water brash from undiagnosed asymptotic GERD? A trial of PPIs is a lot cheaper than an MRI. Link to comment Share on other sites More sharing options...
DJ Bunnell MSHS PA-C Posted September 7, 2010 Share Posted September 7, 2010 I love this thread and am interested in finding out what this turns out to be. The lack of health insurance is going to be tricky. Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 8, 2010 Author Share Posted September 8, 2010 Have you thought about water brash from undiagnosed asymptotic GERD? A trial of PPIs is a lot cheaper than an MRI. Yeah, I thought about this one... I think I will take your advice and try him on it. Since he's not taking any other meds I think he'll be ok. I'll keep you posted. Thanks! Link to comment Share on other sites More sharing options...
marilynpac Posted September 8, 2010 Share Posted September 8, 2010 I thought most water brash was usually "sour"?.... Link to comment Share on other sites More sharing options...
freetv4me Posted September 8, 2010 Share Posted September 8, 2010 I thought most water brash was usually "sour"?.... I've also read that it can also be salty. Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 11, 2010 Author Share Posted September 11, 2010 Ahhhhhhhhh this patient came back and is NOT happy. I told him about the things I have learned from this forum as well as from other sources. Started him on a PPI and gave him a b12 shot. I reiterated that I think an MRI is in order. He balked since he has no insurance. I am now trying to shop around for the cheapest MRI in the area. At this point, he thinks I'm an idiot. I'm frustrated because the elepahnt in the room is his 2 pack a day smoking, which he will NOT give up. And yet, he doesn't think it has anything to do with his disgeusia. More suggestions? Link to comment Share on other sites More sharing options...
bradtPA Posted September 11, 2010 Share Posted September 11, 2010 A neuro consult? If he doesn't like what you have done, turf him to the sensory specialist.... Link to comment Share on other sites More sharing options...
TXPA23 Posted September 12, 2010 Share Posted September 12, 2010 dysgeusia can also be from Zn deficiency... Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 13, 2010 Author Share Posted September 13, 2010 brad: I doubt he will be willing to go to neuro... he has to pay out of pocket and he is not happy about any of it. TX: I told him that, and advised him to take more zinc. He looked at me like I had sprouted another head. Thanks, though! Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 16, 2010 Author Share Posted September 16, 2010 Update: My SP suggested a nasal steroid spray, saying that what he smells, he tastes. OK. Done. Will let you know what happens. The patient is still smoking and no one seems to think that this is a contributing factor. Alas. Link to comment Share on other sites More sharing options...
marilynpac Posted September 16, 2010 Share Posted September 16, 2010 I took care of a pt ONCE that had a four pack a day habit on my rotations. His legs in a dependant position turned black, I could find no pedal pulses. He looked at me and said "Marilyn, don't smoke." I told him not to worry. I envision a future where people who smoke are going to be embarrassed into quitting. Hopefully our gov will tax this so high that people can't afford them and people will be too lazy to roll their own. Link to comment Share on other sites More sharing options...
Leeg Posted September 16, 2010 Share Posted September 16, 2010 Quote- Re: salty taste in mouth If he was craving salt I would think adrenal glands. I wonder if it could still be overactive / underactive adrenal gland? Clever, young Jedi. I am reaching with the heavy metal tests. Evan, he is not taking any meds. He takes a multivitamin every day. Leeg: he does not crave salt. He said he liked a lot of salt but has cut back and it didn't change his symptoms. A slow CSF leak could do it... I will have to try to convince him to pony up the $$$ for an MRI (he has no insurance--- of course). Roman: boooooooooooooo that was soooooooo wrong. Funny, but wrong. And sometimes "it" isn't salty, sometimes "it" is sweet. I heard eating lots of pineapples does that. Don't ask me how I know this. That's why I said in my reply " If he was craving salt..." I should have emphasized the word IF. Link to comment Share on other sites More sharing options...
freetv4me Posted September 16, 2010 Share Posted September 16, 2010 Update: My SP suggested a nasal steroid spray, saying that what he smells, he tastes. OK. Done. Will let you know what happens. The patient is still smoking and no one seems to think that this is a contributing factor. Alas. What he smells, he tastes? Does that mean you live on the coast? What about other smells/tastes? Link to comment Share on other sites More sharing options...
Evan Posted September 16, 2010 Share Posted September 16, 2010 Maybe look into a psych componant to his complaint... before anyone laughs, stick with me now... Perhaps he is embarrassed to seek care for his depression, anxiety, whathaveyou, and this off-the-wall complaint is his way of easing into asking for help... I had a patient last week who came in for a low-grade-fever and we spent 10% on her 98.9 F temp and 90% talking about her kids having a rough time accepting her cancer diagnosis... Link to comment Share on other sites More sharing options...
JFarnsworth Posted September 16, 2010 Author Share Posted September 16, 2010 freetv: I think what my SP was trying to say is that most of the time, you taste only what you can smell. My patient does not live by the coast :) Evan: I hear you on that one. I will approach the subject gently at his follow up. Link to comment Share on other sites More sharing options...
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