A 39 year old delivery man is admitted in the afternoon following a generalized tonic-clonic convulsion which lasted for 5 minutes. He had been transporting parcels by bicycle for the whole day. He was completely well earlier, with an unremarkable medical and drug history. An urgent full blood count and non-contrast CT brain are normal, while an ECG shows sinus tachycardia only. His capillary glucose is 125 mg/dl.
Appearance: Clear WBC: No polymorphs RBC: nil Gram stain: negative Glucose: 90 mg/dl (normal) Protein: 25 mg/dl (normal)
The arterial blood gas assay shows metabolic acidosis. The pH is 7.3
CPK: 478 IU/L (Normal: 8 - 150) CPK-MB: 5.1 IU/L (Normal: < 18)
S. Creatinine: 2.3 mg/dl (normal: 0.5 - 1.5 mg/dl) Na: 145 mEq/l (normal) K: 5.0 mEq/l (normal) Cl: 101 mEq/l (normal)