Question

An 72 years old elderly man collapsed and was found in an elevator.
His breathing is slow and deep. The man looks a bit red on the face and only responds to calls. His reactions on pain stimuli are repelling.

Via the GCD he ends up in the hospictal where upon physical examination a blood pressure of 180/115 mmHg was found with a pulse of 58 bpm.

Lab results are as following:

Biochemistry reference value
Creatinine 98 50 - 120
Na 144 136 - 146
K 3.2 3.8 - 5.0
Cl 98 99 - 108
HCO3 27 23 - 29
Glucose 7.8 3.6 - 5.6

Hematology
Hemoglobin 8.6 8.6 - 10.7
Hematocrit 0.43 0.41 - 0.55
leucocytes 8.2 4.0 - 10.0
Platelets 208 150 - 450
MCV 90 80 - 97
BSE 4 1 - 10

Bloodgas analysis
pH 7.402 7.37 - 7.45
pCO2 40 35 - 45
pO2 84 70 - 100
O2 saturation 90% 96 - 100
HCO3 28 21 - 26

What diagnosis springs to mind??
I have a few thoughts but I would like to hear some other opinion.

Answer 1

@oOKawaiiOo any ideas?

Answer 2

what is his past medical history?

Answer 3

I wanna throw in Pulmonary edema, respiratory distress.....

Hypokalemia........

Loss of conscious......

He has high volume in his blood due to high extracellular electrolytes.

Answer 4

The case has the following diagnosis options:

- Chronic obstructive pulmonary disease
Explains low O2 saturation and deep breathing.

- Hyperventilation syndrome
I don't think it's this one as he's breathing slowly, it's usually rapidly breathing.
Besides, the pCO2 would be very low and pH would be high due to respiratory alkalosis but neither of those are.

- Hyperglycemic (diabetic) coma
Explains high sugar level

- Cerebovascular accident (stroke)
Don't think it's this one either. High glucose can cause symptoms that look like a stroke but this is usually not the case.

Answer 5

I've read through this. ^ Outside of a high glucose reading and high BP, nothing else looks out of the ordinary. His potassium seems low, as do some of his blood oxygen indicators - like O2 saturation. So possibly some sort of hypokalemia (salt levels low), or some sort of circulation problem.

The hyperglycemic makes the most sense of the 3 that you've listed above.
Possibly some sort of anemia, with the low hemoglobin, and the low O2 saturation.

Answer 6

I can interpret the lab results a little, but I don't know much about their medical significance - especially with a case study like this.

Answer 7

Could also be type II diabetes. The glucose, blood sugar - being high. The only thing that is out of whack.

Answer 8

Stroke would have a lot of other symptoms, too, I think.

Answer 9

So… diabetes is what I would go for

Answer 10

Unless stated in his past medical history if he has diabetes...... We dont know if he is DKA.