House S08EP11 “Nobody’s Fault”

He who smelt it, dealt it.

According to the promos, the next episode of House appears to be a flashback style episode, with the final big reveal to be doled out gradually. A case goes awry, and House’s team is investigated by Foreman’s former mentor and Chief of Neurology, Dr. Walter Cofield. Each team member recounts their side of the story throughout the show, and in the end Cofield must determine whether House’s unconventional approach is warranted by the results.  How will he decide? Check back Monday at 8, and then next week for the first episode of Cofield, MD!  Back with an update Tuesday afternoon! 

I actually was only able to catch the second half of the episode, as the ladies were controlling the clicker and wanted to watch How I Met Your Mother. Oh, Marshall:  why did you think it was a good idea to let your father-in-law keep bees in the basement? That could never end well!

Back to House: the patient of the week collapsed while jogging. Other symptoms that occurred during the differential diagnosis included bloody sputum, erratic potassium levels, and more significantly, paralysis of all four extremities. Several theories are offered to explain the patient’s symptoms, and are narrowed down to either Wegener’s disease, invasive strep, or psychosis brought on by the initial steroid treatment. House pushes to use a diagnostic trial, where a single treatment would result in a cure for one of the possibilities, and the patient crashing for the other two, which would then lead the diagnostic team to the correct answer and treatment. House didn’t consider the third possibility, which was that the patient would pick up a scalpel and stab Chase, which is where I picked up the episode.

It appears that Chase will be OK after a convalescence, and our patient of the week is finally diagnoses with Tumor Lysis Syndrome, due to a blunt force trauma damaging a tumor in his lymph nodes. TLS is a metabolic disease marked by a spike in potassium levels from dead and dying tumor cells, typically as a complication from chemotherapy. The steroid therapy early in the episode exacerbated the symptoms. Because TLS is a known complication in cancer treatment, cancer patients may be put on prophylactic uric acid inhibitors to prevent the condition. Treatment of preexisting TLS involves hemodialysis, where the toxic metabolites are removed from the blood and the blood replaced.



About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on February 5, 2012, in House Party!. Bookmark the permalink. 2 Comments.

  1. I have never watched House before but I gave it try yesterday. Embarrassingly, the show seemed way over my head at times. I found it interesting when one character said that House does not feel it is important to be in the room with a patient to treat them, or something to that effect.

    • Well, House’s mantra (besides “It’s Not Lupus”) is “Everybody lies,” so it makes sense that he might feel that it is not necessary to take a patient’s history from the patient. That is why a frequent plot device on the show is for his team to break into the patient’s home looking for suspected clues that would be relevant in the diagnosis.

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