Case Study
A previously healthy 16-years-old girl was found unconscious late at night following a domestic argument. When examined on admission, she was hyperventilating, responded to painful stimuli, and had dilated pupil which responded to light. The rest of the physical examination was unremarkable. Her urine was negative for glucose and ketone and the rest of the laboratory analysis are in table one.
Test
Results
Reference range
Plasma
Na
141 mmol/L
132-144
K
3.4 mmol/L
3.2-4.8
Cl
100 mmol/L
98-108
HCO3
16 mmol/L
23-33
Urea
6.5 mmol/L
3.0-8.0
Creatinine
80 mmol/L
60-120
Agap
25 mEq/L
6-16
Gluc
5.5 mmol/L
3.5-5.5
Osmo
299 mmol/kg
282-292
TP
70 g/L
63-80
Alb
43 g/L
32-50
ALT
15 U/L
<40
TBili
12 μmol/L
<20
Ca
1.86 mmol/L
2.15-2.55
PO4
0.9 mmol/L
0.65-1.25
Blood
pH
7.45
7.35-7.45
PO2
112
80-110
PCO2
21
35-45
HCO3
15
23-33
1) Comment on the clinical picture and the laboratory results
2) Is there are any other laboratory investigations would you consider? Also, why?
3) What is the most likely diagnosis?
