08-04-2011, 06:17 AM
A man is brought to the hospital with a depressed level of consciousness.
He was found by the police beside a dumpster behind
an automotive shop. He has no identification. On examination,
his supine pulse rate is 108 beats per minute and supine blood
pressure is 98/64 mm Hg; orthostatic changes cannot be determined
because the patient cannot sit upright. His breath has a
sweet, fruity odor. The optic fundi appear normal, and both
pupils react briskly to light. Cardiovascular examination is unremarkable
except for regular tachycardia. The abdomen is not
tender. No peripheral edema is present. There are no suspicious
skin lesions. Laboratory evaluation showed the following:
Plasma glucose, mg/dL 100
Blood urea nitrogen, mg/dL 16
Serum creatinine, mg/dL 1.0
Serum electrolytes
Sodium, mEq/L 138
Potassium, mEq/L 3.9
Chloride, mEq/L 101
Bicarbonate, mEq/L 10
Arterial blood studies
PO2, mm Hg 134
PCO2, mm Hg 28
pH 7.28
Urinalysis showed sheets of needle-shaped, monohydrate calcium
oxalate crystals.
Which of the following is the most likely diagnosis?
a. Methanol intoxication
b. Crystal methamphetamine overdosage
c. Ethylene glycol intoxication
d. Alcoholic ketoacidosis
e. Salicylate overdosage
He was found by the police beside a dumpster behind
an automotive shop. He has no identification. On examination,
his supine pulse rate is 108 beats per minute and supine blood
pressure is 98/64 mm Hg; orthostatic changes cannot be determined
because the patient cannot sit upright. His breath has a
sweet, fruity odor. The optic fundi appear normal, and both
pupils react briskly to light. Cardiovascular examination is unremarkable
except for regular tachycardia. The abdomen is not
tender. No peripheral edema is present. There are no suspicious
skin lesions. Laboratory evaluation showed the following:
Plasma glucose, mg/dL 100
Blood urea nitrogen, mg/dL 16
Serum creatinine, mg/dL 1.0
Serum electrolytes
Sodium, mEq/L 138
Potassium, mEq/L 3.9
Chloride, mEq/L 101
Bicarbonate, mEq/L 10
Arterial blood studies
PO2, mm Hg 134
PCO2, mm Hg 28
pH 7.28
Urinalysis showed sheets of needle-shaped, monohydrate calcium
oxalate crystals.
Which of the following is the most likely diagnosis?
a. Methanol intoxication
b. Crystal methamphetamine overdosage
c. Ethylene glycol intoxication
d. Alcoholic ketoacidosis
e. Salicylate overdosage