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14th August 2024
A 49-year-old female is brought to the Emergency Department with a reduced level of consciousness
A 49-year-old female is brought to the Emergency Department with a reduced level of consciousness. Her daughter has visited her for the first time in several years as a result of Covid-related travel restrictions and had to summon the police to gain entry to her flat, where she was found unconscious. She has previously been fit and well but recently complained of fatigue that was preventing her from working.
Observations are taken: heart rate 42 bpm (sinus rhythm), blood pressure 97/70 mmHg, respiratory rate 7/minute, SpO2 96% on air, temperature 33.6℃.
On examination, her GCS is E1V1M4, but she is maintaining her own airway. You note vitiligo. There are otherwise no focal findings.
A venous blood gas is returned:
| pH | 7.36 | (7.35-7.45) |
| pO₂ | 9.7 | (10-12) |
| pCO₂ | 6.4 | (4.5-6) |
| Na⁺ | 121 | (135-145) |
| K⁺ | 4.2 | (3.5-5.5) |
| HCO₃⁻ | 28.4 | (22-26) |
| Lac | 3.1 | (0-2) |
| Glu | 2.3 | (4-7.8) |
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