Comatose

An 80 year old woman is brought in semi-conscious. She had been lethargic for the last several weeks and was unable to get out of bed yesterday. She has no known comorbidities.

A full blood count, c-reactive protein, capillary blood sugar, chest x-ray and CT brain are normal. Her ECG shows sinus bradycardia with low voltage complexes, while cardiac troponins are not elevated.

Select Relevant Investigations
Serum Electrolytes

Performed

Na+ 125 mEq/l
K+ 3.9 mEq/l
Cl- 103 mEq/l
Thyroid Function Tests

Performed

TSH: 100 mIU/l (range: 0.4 to 4 mIU/l)
Free T3: undetectable
Free T4: undetectable
Arterial Blood Gases

Performed

PaO2: 68 mmHg (range: 75 - 100)
PCO2: 50 mmHg (range: 36 - 44)
HCO3: 27 mmol/l (range: 22 - 26)
pH: 7.32 (range: 7.35 - 7.45)
Urinalysis

Performed

Pus cells: field full/hpf
RBC: 5 - 6/hpf
Gram stain: Gram negative bacilli

Select Relevant Management
IV Thyroxine
IV Antibiotics
IV Adrenaline
Intubation and Ventilation