Case #2:  Unresponsive at 18(And this is unusual?)

History

The patient is a 18 year old male presenting to the ED by paramedics after found at home unresponsive, face down in bed. According to friends, the patient had consumed several beers and wine earlier that day following a period of depression. The patient was orally intubated in the field by paramedics after no response to D50 and naloxone administration.

Physical Exam:

• General: Patient responsive only to deep painful stimuli
• Vitals: BP 150/70, HR=92, RR=24, T=95.4F
• Lungs: CTA, BS Equal, (Intubated)
• CV: RRR, no murmur
• Abd: Soft, Non-Tender, No Trauma, No Masses
• Rectal: Normal Tone, Heme-
• Neuro: DTR's Hyporeflexive, Withdraws to Painful Stimuli

Diagnostic Studies

• CBC: WBC 29K HCT=45
• Lytes: Na=145 Cl=105 K=5.2 HCO3=5
• BUN/Cr: 28/1.8 Glucose 180
• ABG: 6.97 PO2=321 PCO2=15
• Osm: 370 (Measured)
• ETOH: 46
• Calcium 7.0
• Toxicology Screen: Pending
• Toxic Alcohols: Pending
• Urine Microscopy:(Press to see image)

• CXR: ET tube above carina, no infiltrates, no edema.
• ECG: NSR, No ischemic changes.

Toxin and Discussion:

Questions and Controversial Issues References