Acute Hemodynamic Decompensation Following Routine Phlebotomy in a Patient with Chronic Volume Dysregulation: A Five-Week Longitudinal Provocation Sequence

A 48-year-old male (DOB 7/5/1969) with a documented history of chronic volume dysregulation and suspected endocrine axis disruption underwent routine whole blood donation as a self-initiated provocation test. Within 24-48 hours, the patient experienced a transient hypercortisolemic state (subjective mania), followed by acute vestibular failure on day three, persistent nausea and orthostatic symptoms over the subsequent four weeks, and a near-syncopal collapse on day 34 triggered by THC-induced vasodilation. Throughout the collapse event, the patient maintained full consciousness despite documented blood pressure of 90/54 mmHg post-saline resuscitation. Serial laboratory evaluation revealed prerenal azotemia…