27th February 2025

A 39-year-old man is brought to the emergency department by ambulance. He is unresponsive

A 39-year-old man is brought to the emergency department by ambulance. He is unresponsive, and the ambulance crew inform you that he collapsed at home and was initially found to have a blood glucose of 3.1, which has improved to 5.6 after intravenous glucose administration.

His current observations are as follows: heart rate 112 bpm, blood pressure 86/43 mmHg, respiratory rate 18, oxygen saturation 95% on room air, temperature 36.4 degrees.

Admission bloods show: Hb 121 g/L (115-165 g/L), WCC 7.6 x 10⁹/L (4.0-11.0 x 10⁹/L), Na 129 mmol/L (133-146 mmol/L), K 5.7 mmol/L (3.5-5.3 mmol/L), creatinine 110 µmol/L (45-104 µmol/L), urea 6.8 mmol (2.5-7.8 mmol/L), CRP 8 mg/L (<5 mg/L).

His partner arrives and tells you that for the last 7 days, he has been complaining of generalised fatigue and headaches. He is being monitored by his oncologist as he has a background of urothelial cancer and recently completed treatment with the immune checkpoint inhibitor atezolizumab. He has not received any atezolizumab for 6 weeks. His other past medical history only includes eczema, which is well controlled at present.

Which of the following would form part of the emergency management of this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.