pulling apart cases from the ED...
the case.
43 year old female is brought into your resuscitation bay by the paramedics. She has a 2 day history of vomiting and diarrhoea on the background of type 2 diabetes and alcohol abuse. Her son is concerned that she has become increasingly confused despite drinking her usual amount of alcohol.
the case.
a 28 year old female is brought into your resuscitation bay by paramedic crews following a two day history of nausea and vomiting. As she rolls past, you notice that she is distressed with pain, looks clinically very dry and is quite drowsy.
The Case.
64 year old male attends your ED with a complaint for 3 months of progressive weakness, however over the past 7 days he has had multiples falls secondary to his ‘legs just completely giving way’. You note on the hospital records that he has a history of alcoholism (150-250 grams per day). After a long & drawn out discussion (think, blood from a stone) in an attempt to elaborate his history, you gain the knowledge that …
He has no known past medical history & takes no regular medications.
He looks crook. Pale, diaphoretic and clammy. Tachycardic (@120/min) and hypertensive (165/110 mmHg). He is afebrile however. No murmurs, chest clear. Tender hepatomegaly. No midline back pain. Normal power, sensation and reflexes to both legs (with good peripheral pulses).
Here is his venous blood gas and accompanying chemistry….
What are your thoughts ?
Differential diagnoses ??
What are you going to do next ???