Author: Vibhor Tiwari / Editor: Nick Tilbury / Codes: EnP1, NepP1, RP8, SLO1 / Published: 27/04/2023

A 46-year-old male arrives via ambulance to the Emergency department (ED) having been found, minimally conscious and with blood coming out of his mouth. He has a background of alcohol dependence and he was seen in your ED only 7 hours ago.

He presented at that time with signs of alcohol withdrawal, for which he was treated appropriately and discharged.

Investigations from that attendance were unremarkable, including a sodium level of 135.

Observations this time are:

  • BP 120/80
  • HR 88
  • RR 16
  • Sp02 100% o/a
  • Temp 37

On examination his chest is clear, and his abdomen is soft and non-tender. His GCS is 10 (E4 M4 V2) and his pupils are equal and reactive bilaterally. His blood glucose is 7.7. Apart from some bleeding from a wound to his tongue, there is no evidence of any injuries.

You do a VBG:

  • pH 7.35
  • PO2 12.9
  • PCO2 3.8
  • BE -8.2
  • Lactate 7.1
  • Hb 114
  • Na 108
  • K 4.1

ECG shows normal sinus rhythm and urine toxicology is negative.

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