Obtunded

Multisystem Processes & Disorders


Step 1: View Clinicals

A 6 year old girl presents with diffuse abdominal pain, profuse vomiting, blurred vision, agitation, a generalized headache, and worsening dyspnea for 4 hours. She also started wheezing 30 minutes ago.


Her medical and surgical histories are unremarkable, and there is no family history of bronchial asthma. Her growth and development are age appropriate.


Her random plasma glucose is 110 mg/dL, while a complete blood count is within normal parameters.


Step 2: Order Relevant Investigations

1. Arterial Blood Gases + Electrolytes

check

FiO2: 45%

pH: 6.9 (7.34-7.44)

PaO2: 108 mmHg (75-100)

PaCO2: 26 mmHg (35-45)

HCO3-: 3 mEq/L (22-26)

Anion Gap: 23 mEq/L (<16)

Na+: 133 mEq/L (135-145)

K+: 5.5 mEq/L (3.5-5.5)

Cl-: 105 mEq/L (97-105)

2. Serum Lactate

check

Serum Lactate: 0.6 mmol/l (0.5 - 2.2)

3. Liver Profile + Renal Function Tests

check

AST: 4490 IU/L (7-55)

ALT: 8030 IU/L (8-48)

ALP: 110 IU/L (45-115)

Albumin: 4.5 g/dL (3.5-5)

Total Protein: 7.0 g/dL (6.3-7.9)

Bilirubin: 0.3 mg/dL (0.1-1.0)

INR: 1 (0.9-1.1)

Blood Urea: 37 mg/dL

Serum Creatinine: 0.4 mg/dL

4. Toxicology Screen

check

Acetaminophen: undetectable

Salicylates: undetectable

Ethyl Alcohol: undetectable

Methanol: 67 mg/dL

Ethylene Glycol: undetectable

Isopropyl Alcohol: undetectable

Step 3: Select Appropriate Management

1. Urgent Hemodialysis

check

2. Fomepizole

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3. IV Sodium Bicarbonate

check

4. Insulin

clear