Author: Fiona Mendes / Editor: Yasmin Sultan / Codes: EnvC1, SLO3Published: 12/01/2022

A 68-year-old lady was working outdoors, gardening during a hot summers’ day. She started having leg cramps and felt light-headed with a headache.

Later that afternoon, when her family visited for an outdoor picnic, she started hallucinating, becoming confused and disorientated. 

She arrives by ambulance to your Emergency Department with fluctuating levels of consciousness. Despite having paracetamol, her temperature persists at 42.3oC.

On arrival, she is hyperventilating.  Oxygen saturations are 97% in room air, respiratory rate 26 breaths per minute, heart rate 110 beats per minute and blood pressure 86/42 mmHg. Glucose level is 4.2 mmol/L.

There are no features of infection. No known trauma.

Her family report that she takes a diuretic and Bisoprolol for hypertension. She was previously well and lives independently.

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