Author: Nathan Ivey, Sarah Evans, Syed Gilani / Editor: Stephen Sheridan / Codes: PhC1, PhC3, PhP1, PhP2, SLO1 / Published: 12/12/2025
An 83-year-old male is pre-alerted to your emergency department (ED) following an intentional overdose of one of his medications. On arrival, he admits to taking the medication around 12 hours ago with the intent to end his own life. He complains of having a dry mouth and experiencing left-sided flank pain, which is dull in nature and constant. He states he is nauseated and has vomited twice at home and has had some diarrhoea.
He has a past medical history of hypertension, atrial fibrillation, stroke, gout, benign prostatic hypertrophy, and retinal detachment leading to left eye evisceration. He is taking various medications for these conditions.
His observations on arrival are: respiratory rate 24, O2 sats 96% on room air, heart rate 116 bpm irregularly irregular, BP 90/58, GCS 15/15, single pupil reactive to light 3mm, temperature 37.1°C.
On examination, he is alert. Tenderness noted on abdominal palpation; otherwise, nothing else of note. His ECG shows fast atrial fibrillation. IV access is gained, routine overdose bloods are taken, and a VBG is analysed (results shown below):
- pH 7.32
- PCO2 6.06
- pO2 3.26
- HCO3 23.2
- BE -3.2
- Na 145
- K 2.6
- Glucose 3.2
- Lactate 7.9
4 responses
Excellent
Very good article, thank you 🙂
not much common in practice and good refreshment
excellent case