Author: Ruaridh Thow / Editor: Nick Tilbury / Reviewer: Philip Delbridge / Codes: NepC3, NepC4, NepP1, SLO2, SLO3 / Published: 28/12/2021 / Reviewed: 20/12/2024
A 63-year-old female re-presents to the Emergency Department (ED) after having been discharged earlier that day. A few hours ago, she had arrived at the ED complaining of feeling generally anxious and unsteady on her feet. She also mentioned that she could still taste a greasy meal she had eaten the night before. She was diagnosed with anxiety and sent home.
She is now still complaining of the above symptoms but also states she has been feeling ‘not right’ for the last 10 weeks. She admits to self-harm by consuming burning hot food and putting various creams in her eyes, and also divulges that she has overdosed on antacid tablets, having consumed approximately 60 over the last 3 days. She has been repeatedly calling 111 as she is so anxious and a relative in attendance reports that she thinks she had a seizure yesterday.
PMH – agoraphobia, anxiety, type-2 diabetes
She currently takes no regular medication but recently has stopped using Olanzapine.
Her observations are as follows:
- SPO2 on air 93%,
- RR 16
- HR 80 – regular with good radial volume
- BP 120/80
- Temp 37
- GCS 13 (E3 V4 M6)
On examination, she is drowsy and confused. She is repeatedly asking for water and complaining of excessive thirst.
Whilst in the department she has a tonic-clonic seizure, which self-resolves within 2 minutes. Afterwards she is post-ictal. Her ECG is normal.