Management of snake bite
A 32 year old otherwise fit male from regional New South Wales presents with acute onset of headache, abdominal pain, confusion and agitation. He has been working in the garden all day on a hot summer day. On examination, he was a bit clammy at the extremities. Temp 38.5 C. The rest of the examination was unremarkable.
His initial bloods:
|
Hb |
110 g/L |
(130-150) |
|
WCC |
14.0 X 109/L |
(4.0-11.0) |
|
Platelets |
220 |
(150-300) |
|
INR |
10 |
(0.8-1.2) |
|
APTT |
>120 sec |
(34-38) |
|
Fibrinogen |
<1.0 g/L |
(1.5-4.0) |
|
Na |
144 mmol/L |
(135-145) |
|
K |
5.1 mmol/L |
(3.5-5.0) |
|
Creatinine |
180 μmol/L |
(40- 110) |
|
Urea |
20 mmol/L |
(4.0-6.0) |
|
Creatinine Kinase |
255 U/L |
(<50) |
|
Lipase |
436 U/L |
(<200) |
|
ALT |
80 U/L |
(<40) |
|
AST |
92 U/L |
(<40) |
What is the differential diagnosis?
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.