Urgent 2

 

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?