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.