Author: Mohamed Ibrahim / Editor: Sarah Edwards / Codes: MHC3, SLO12 / Published: 12/01/2024

A 45-year-old male patient, who has been referred from a mental health facility, presents to the Emergency Department (ED) with complaints of acute dyspnoea and new hypoxia.

The symptoms started following two separate episodes of patent ingestion of his own faeces (coprophagy). The first incident occurred approximately seven days prior to the presentation, and the second one just a few hours before the patient arrived at the ED. The patient didn’t report any other concurrent symptoms.

The patient’s medical history includes hypertension and schizophrenia.

On physical examination, the chest has revealed equal bilateral air entry, with no discernible added respiratory sounds. The abdominal examination has revealed laxity without tenderness. Oxygenation monitoring demonstrates a peripheral capillary oxygen saturation (SpO2) of 92% while receiving 15 litres of supplemental oxygen, a pulse rate of 92 beats per minute, a respiratory rate of 28 breaths per minute, a blood pressure reading of 125/81 mmHg, and a Glasgow Coma Scale (GCS) score of 15 out of 15, oriented to time and place with no focal neurology.

At this point, observation is as follows:

BP: 125/82
HR: 92
RR: 28
SPO2: 92% on 15L oxygen

And the abg shows:

pH 7.42,
pCO2 3.8 mmHg
pO2 37.6 mmHg
Met HB: 2.3

HB: 120 g/L
PLT: 271 109/L WBC:4.1 109/L
CRP: 1mg/L
DDimer: 136 ng/mL
Sodium: 137mmol/L
Potassium: 4.5 mmol/L
Urea: 17mmol/L
Creatinine: 89 mmol/L

CXR: no abnormalities detected.

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