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22nd May 2025
A 45-year-old presented to casualty with a headache and subsequently had a seizure in the department.
A 45-year-old presented to casualty with a headache and subsequently had a seizure in the department. She is accompanied by her daughter, who reports her mother has not attended dialysis sessions for one week and has not been taking medications. She had two episodes of vomiting and was also disoriented. Her regular medications include Aspirin 75 mg OD, Hydralazine 50 mg BD, Nifedipine 30 mg BD, Metoprolol 50 mg OD, Ramipril 5 mg OD, Atorvastatin 40 mg OD and Calcium Carbonate 500 mg BD. Her CT head is unremarkable.
Observations:
| Blood Pressure | 180/110 mm HG |
| Heart Rate | 108 /min |
| SpO2 | 96% on RA |
| Temperature | 36.1 ⁰C |
Laboratory analysis:
| Haemoglobin | 9.0 g/dl | Sodium | 138 mmol/dl | CSF RBC | 1 |
| White Blood Corpuscles | 12.0 x 10^6 | Potassium | 5.4 mmol/dl | CSF WBC | 0 |
| Platelets | 400 x10^6 | Corrected Calcium | 2.22 mmol/dl | CSF protein | 1.1 |
| Creatinine | 998 mmol/dl | Phosphate | 2.1 mmol/dl | CSF Glucose | 4 .3 |
| Urea | 37.6 mmol/dl | CRP | 0.3 mg/l | ||
| Albumin | 31 mg/l | Glucose | 5.1 mmol/dl | ||
What is the most likely diagnosis?
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