A 22-year-old male is brought into the Emergency Department with a decreased conscious state with a history of having been missing for over twenty-four hours. Results of his investigations are given below:
|
Parameter |
Patient Value |
Adult Normal Range |
|
Sodium |
149 mmol/L* |
135 – 145 |
|
Potassium |
6.0 mmol/L* |
3.5 – 5.0 |
|
Chloride |
114 mmol/L* |
95 – 105 |
|
Bicarbonate |
19.0 mmol/L* |
22.0 – 26.0 |
|
Creatinine |
210 μmol/L* |
45 – 90 |
|
Urea |
10.1 mmol/L* |
3.0 – 8.0 |
|
Calcium |
1.75 mmol/L* |
2.10 – 2.60 |
|
Phosphate |
2.29 mmol/L* |
0.80 – 1.50 |
|
Magnesium |
1.42 mmol/L* |
0.70 – 1.30 |
|
Albumin |
21 g/L* |
35 – 50 |
|
Alkaline phosphatase (ALP) |
62 IU/L |
< 120 |
|
Gamma-glutamyl transferase (GGT) |
22 IU/L |
< 50 |
|
Alanine aminotransferase (ALT) |
424 IU/L* |
< 55 |
|
Aspartate aminotransferase (AST) |
1679 IU/L* |
< 50 |
|
Total bilirubin |
12 μmol/L |
< 19 |
|
T Protein |
38 g/L* |
60 – 82 |
|
Creatinine Kinase |
10315 IU/L* |
< 175 |
a) Give the likely diagnosis and list five possible underlying causes. (30% marks)
Not available.
What happened to this random dude?
So, everything looks like rhabdomyolysis, with a bit of kidney injury perhaps from the myoglobin-related damage or perhaps from the dehydration related to being collapsed on the kitchen floor for a day. Now we have to come up with five reasons why. There are literally a million possible causes of rhabdomyolysis, and the successful candidate would need to identify five which are associated with a decreased level of consciousness. Drugs trauma and environmental exposure would have to be on that list, because young people do be like that.
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