A 39 year old delivery man is admitted in the afternoon following a generalized tonic-clonic convulsion which lasted for 5 minutes. He had been transporting parcels by bicycle for the whole day.

He was completely well earlier, with an unremarkable medical and drug history. An urgent full blood count and non-contrast CT brain are normal, while an ECG shows sinus tachycardia only. His capillary glucose is 125 mg/dl.

Select Relevant Investigations
Lumbar Puncture


Appearance: Clear
WBC: No polymorphs
RBC: nil
Gram stain: negative
Glucose: 90 mg/dl (normal)
Protein: 25 mg/dl (normal)
Arterial Blood Gases


The arterial blood gas assay shows metabolic acidosis. The pH is 7.3
Creatine Phosphokinase (CPK)


CPK: 478 IU/L (Normal: 8 - 150)
CPK-MB: 5.1 IU/L (Normal: < 18)
Creatinine & Electrolytes


S. Creatinine: 2.3 mg/dl (normal: 0.5 - 1.5 mg/dl)

Na: 145 mEq/l (normal)
K: 5.0 mEq/l (normal)
Cl: 101 mEq/l (normal)

Select Relevant Management
Evaporative cooling
IV Fluids
IV Antibiotics