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A previously healthy 16-years-old girl was found unconscious late at night following a domestic argument. When examined on admission, she was hyperventilating, responded to painful stimuli, and had dilated pupil which responded to light. The rest of the physical examination was unremarkable. Her urine was negative for glucose and ketone and the rest of the laboratory analysis are in table one.
|
Test |
Results |
Reference range |
|
Plasma |
||
|
Na |
141 mmol/L |
132-144 |
|
K |
3.4 mmol/L |
3.2-4.8 |
|
Cl |
100 mmol/L |
98-108 |
|
HCO3 |
16 mmol/L |
23-33 |
|
Urea |
6.5 mmol/L |
3.0-8.0 |
|
Creatinine |
80 mmol/L |
60-120 |
|
Agap |
25 mEq/L |
6-16 |
|
Gluc |
5.5 mmol/L |
3.5-5.5 |
|
Osmo |
299 mmol/kg |
282-292 |
|
TP |
70 g/L |
63-80 |
|
Alb |
43 g/L |
32-50 |
|
ALT |
15 U/L |
<40 |
|
TBili |
12 μmol/L |
<20 |
|
Ca |
1.86 mmol/L |
2.15-2.55 |
|
PO4 |
0.9 mmol/L |
0.65-1.25 |
|
Blood |
||
|
pH |
7.45 |
7.35-7.45 |
|
PO2 |
112 |
80-110 |
|
PCO2 |
21 |
35-45 |
|
HCO3 |
15 |
23-33 |
1) Comment on the clinical picture and the laboratory results
2) Is there are any other laboratory investigations would you consider? Also, why?
3) What is the most likely diagnosis?
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