ERDoc Posted January 14, 2015 Author Posted January 14, 2015 No history of migraines. You obtain a rectal temp and it is 35.4. The pt has not been outside. Labs: Na 131 K 2.4 Cl 114 CO2 20 BUN 17 Creat 0.64 Glucose 107 WBC 14.7 Hgb 17.3 Hct 48.7 Plt 286 CT of the head shows a left frontal subarachnoid bleed
Just Plain Ruff Posted January 15, 2015 Posted January 15, 2015 He needs surgical intervention I believe. Get him to the OR STAT!!!!!!!!!
ERDoc Posted January 15, 2015 Author Posted January 15, 2015 It was an interesting case. It would have been so easy to just say that it was his tooth and send him on his way. It was the temp that made me take a second look and start a work up. Always question abnormalities. In the end, the working diagnosis right now is that he smoked some marijuana that was unexpectedly laced with something, which caused a vasculitis which bled. Still no explanation for the sepsis/SIRS.
systemet Posted January 19, 2015 Posted January 19, 2015 I'm not great at reading labs, but his CO2 is 20, so his HCO3- is probably around 18 mM, right? So, is the metabolic acidosis here just lactic acidosis? Also, why the hypokalemia / hyponatermia? Is there some SIADH here too? On one hand, his crit's 48, but his calculated osmolarity looks to be around 275? Just wondering. I'm trying to get better with this sort of thing since I got access to an iSTAT and started working in the ER a little on the side.
ERDoc Posted January 19, 2015 Author Posted January 19, 2015 I wouldn't put too much on the sodium, it is just under normal. Hard to say why he was hypokalemic. It was replaced and never an issue again. His lactic acid was elevated at 2.7 which is probably the cause of the acidosis.
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