Instructions
You are a medical student on placement in the emergency department. Your next patient is Colin Dwyer, 79, brought in by his daughter with confusion.
Take a history from the patient and his daughter
Examine the patient
Outline to the examiner:
- Your findings
- Your interpretation of the results
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
FBC and CRP
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 116 g/L | 130-180 g/L |
| White cell count | 18.4 x 10^9/L | 4.0-11.0 x 10^9/L |
| Neutrophils | 16.8 x 10^9/L | 2.0-7.5 x 10^9/L |
| C-reactive protein | 186 mg/L | <5 mg/L |
UEC and glucose
| Item | Value | Reference range |
|---|---|---|
| Sodium | 132 mmol/L | 135-145 mmol/L |
| Potassium | 4.8 mmol/L | 3.5-5.2 mmol/L |
| Urea | 18.2 mmol/L | 2.5-7.5 mmol/L |
| Creatinine | 168 umol/L | 60-110 umol/L |
| eGFR | 34 mL/min/1.73 m2 | >60 mL/min/1.73 m2 |
| Glucose | 13.8 mmol/L | 3.5-7.7 mmol/L |
Liver function and coagulation
| Item | Value | Reference range |
|---|---|---|
| Bilirubin | 92 umol/L | 3-20 umol/L |
| ALP | 486 U/L | 30-110 U/L |
| GGT | 612 U/L | 5-50 U/L |
| ALT | 178 U/L | 5-40 U/L |
| AST | 164 U/L | 5-40 U/L |
| Albumin | 29 g/L | 35-50 g/L |
| INR | 1.4 | 0.9-1.2 |
Venous lactate
| Item | Value | Reference range |
|---|---|---|
| Venous lactate | 4.1 mmol/L | 0.5-2.2 mmol/L |