House 103: Occam’s Razor Review

In this 3rd installation of House M.D. reviews, Brandon and his fiancée are having sex in their house when Brandon suddenly passes out. Brandon ends up in the emergency room where he presents with cough, severe abdominal pain, rash, nausea, hypotension, and fever…

 

House accepts the case after hearing his hypotension does not respond to IV fluids. “That’s just weird..” In the brainstorming DDX session, House starts to say that CBC was unremarkable, abdominal CT was clear. “So what’s wrong with her, people? Cameron corrects House, “Him!” With House’s classic condescending tone, he retorts, “Him. Her. Does it matter? Does anyone think its a testicular problem?” LOL.

 

Cameron says that one disease cannot cause all of these symptoms, going against Occam’s Razor.

Occam’s razor (sometimes spelled Ockham’s razor) is a principle attributed to the 14th-century English logician and Francisan friar William of Ockham.

The principle states that the explanation of any phenomenon should make as few assumptions as possible, eliminating those that make no difference in the observable predictions of the explanatory hypothesis or theory. The principle is often expressed in Latin as the lex parsimoniae (“law of parsimony” or “law of succinctness”): ”entia non sunt multiplicanda praeter necessitatem”, roughly translated as “entities must not be multiplied beyond necessity”. (Source: Wiki)

They treat him for sepsis with broad spectrum antibiotics. House orders a cort-stim test and echocardiogram.

Freeman thinks its got to something viral, so they should start “running gels and titres”. The U&Es came back and indicate kidney failure. Foreman  suggests that the kidney failure is caused by the antibiotics. Typically, low BP and abdo pain is an infection. An abdominal infection causes sepsis. The low BP causes the abdo pain cos’ the intestines don’t get enough blood. Plausible explanation… It however doesn’t explain the cough and rash. 

House disagrees, saying that simultaneous development of hypothyroidism and a sinus infection is more likely.They treat him with intravenous levothyroxine (an artificial thyroid medication) and Unasyn, a pencillin to treat the sinus infection. Again, bollocks. Levothyroxine is given orally. Polite Dissent has also pointed this out.

Foreman and House argue that each of their respective diagnoses more closely conforms to Occam’s razor. Unexpectedly, Brandon’s white blood cell count drops, indicating House and Foreman were both wrong. Brandon’s damaged immune system leaves him vulnerable to the simplest infections. Foreman does a bone marrow biopsy to try to find out why he has leukopenia. 

At the clinic pharmacy, House develops a new theory that Brandon’s cough medicine was accidentally replaced with the gout medicine, colchicine. House explains that colchicine poisoning accounts for all of Brandon’s symptoms save one — his cough. However, a visit to Brandon’s pharmacy appears to rule out the cough medicine as the source of the colchicine.

Undeterred, House pulls out some of Brandon’s hair, which House claims as further support for his theory. It is stupid, because he goes into the clean room, which is totally ridiculous, because even if he was right about the patient’s colcichine overdoes, he still has leukopenia and by exposing him to unnecessary pathogens, an infection can kill!

Anyway, i suspect that is just due to the production side of things. Its more dramatic this way. House orders treatment for colchicine overdose (fab fragments, and Tylenol), and Brandon recovers. The mother has been giving him his “cough medication” in the hospital secretly.

Symptoms of colchicine overdose: Nausea, severe abdominal pain, vomiting, diarrhea, shock, ST segment elevation, paralysis, respiratory failure, liver damage, renal failure, leukopenia, thrombocytopenia, coagulopathy, alopecia, stomatitis. (Source: Drugs.com)

House then raids the clinic pharmacy looking for a form of colchicine that would explain Brandon’s overdose. Chase and Cameron discover from Brandon that his old “cough medicine” tablets didn’t have letters on them, while the genuine cough medicine they provide does. As this scene plays out, House discovers a colchicine pill in the pharmacy that looks similar to Brandon’s old “cough medicine” and compares it to the real one with the letter.

If you liked this installation of reviews of House M.D. TV shows, be sure to bookmark this link “House M.D. Reviews“ as i detail through each episode and see how great the writers are, and if the stuff actually make sense in the medical world.

Related links:

• Occam’s Razor Plot on Wikipedia
• Polite Dissent’s Medical Reviews of House: Occam’s Razor