Obtunded

A 6 year old girl presents with diffuse abdominal pain, profuse vomiting, blurred vision, agitation, a generalized headache, and worsening dyspnea for 4 hours. She also started wheezing 30 minutes ago.

Her medical and surgical histories are unremarkable, and there is no family history of bronchial asthma. Her growth and development are age appropriate.

Her random plasma glucose is 110 mg/dL, while a complete blood count is within normal parameters.

Select Relevant Investigations
Arterial Blood Gases + Electrolytes

Performed

FiO2: 45%
pH: 6.9 (7.34-7.44)
PaO2: 108 mmHg (75-100)
PaCO2: 26 mmHg (35-45)
HCO3-: 3 mEq/L (22-26)
Anion Gap: 23 mEq/L (<16)
Na+: 133 mEq/L (135-145)
K+: 5.5 mEq/L (3.5-5.5)
Cl-: 105 mEq/L (97-105)
Serum Lactate

Performed

Serum Lactate: 0.6 mmol/l (0.5 - 2.2)
Liver Profile + Renal Function Tests

Performed

AST: 4490 IU/L (7-55)
ALT: 8030 IU/L (8-48)
ALP: 110 IU/L (45-115)
Albumin: 4.5 g/dL (3.5-5)
Total Protein: 7.0 g/dL (6.3-7.9)
Bilirubin: 0.3 mg/dL (0.1-1.0)
INR: 1 (0.9-1.1)
Blood Urea: 37 mg/dL
Serum Creatinine: 0.4 mg/dL
Toxicology Screen

Performed

Acetaminophen: undetectable
Salicylates: undetectable
Ethyl Alcohol: undetectable
Methanol: 67 mg/dL
Ethylene Glycol: undetectable
Isopropyl Alcohol: undetectable

Select Relevant Management
Urgent Hemodialysis
Fomepizole
IV Sodium Bicarbonate
Insulin