Masquerade

A 15 year old boy presents with severe vomiting and diarrhea for 1 day and confusion since waking up today. He complained of a fever and sore throat in the 5 days preceding this.

His appetite has been poor for the last few months and he has lost some weight. His medical history is unremarkable.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 14,000/mm3
N: 70%
L: 25%
Hb: 16 g/dL
Hct: 50%
Platelets: 250,000/mm3
Arterial Blood Gases

Performed

PO2: 90 mmHg (normal: > 75)
PCO2: 30 mmHg (normal: 35 - 45)
Ph: 7.35 (normal: 7.35 - 7.45)
HCO3-: 18 (normal 22 - 26)
Renal profile

Performed

Urea: 60 mg/dL (normal: 0 - 50)
S. Creatinine: 1.6 mg/dL (normal: 0.5 - 1.5)

Na+ 127 mEq/L (normal: 135 - 145)
K+ 4.0 mEq/L (normal: 3.5 - 5.5)
Cl- 99 mEq/L (normal: 95 - 110)
Random Cortisol

Performed

6 microg/dL (normal: 5 - 15)

Select Relevant Management
IV Antibiotics
IV 1.8% saline
IV Hydrocortisone stat
Urgent Hemodialysis