Mixed

A 70 year old man presents with altered behavior and slurred speech for one day.

He was previously well, except for longstanding osteoarthritis, for which he consumed over-the-counter analgesics regularly.

A full blood count, random blood glucose, serial ECGs, chest radiograph, urinalysis and liver profile are normal.

Select Relevant Investigations
CT brain

Performed

The non contrast CT of the brain appears normal, with no evidence of hemorrhages, infarcts or cerebral edema.
Arterial Blood Gases

Performed

pH: 7.51 (7.35 - 7.45)
paCO2: 12 mmHg (35 - 45)
paO2: 115 (> 75 on room air)
HCO3: 9 mmol/L
ABE: -12.6
Renal functions & electrolytes

Performed

Urea: 20 mg/dL (0 - 50)
Creatinine: 1.4 mg/dL (0.5 - 1.5)
Na+ 138 mmol/L (135 - 145)
K+ 3.1 mmol/L (3.5 - 5)
Cl- 108 mmol/L (95 - 110)
Toxicology screen

Performed

Acetaminophen: not detectable
Benzodiazepines : not detectable
Barbiturates : not detectable
Tricyclic antidepressants : not detectable
Salicylates: 50 mg/L (2 - 29)

Select Relevant Management
IV Sodium Bicarbonate
Activated Charcoal
Hemodialysis
IV Dextrose