A 34 year old woman is brought to ED by ambulance. She is travelling WA with her partner, who witnessed her lose consciousness, bite her tongue and experience jerking of her arms and extended legs for 2 minutes, followed by a period of confusion. she was back to normal within 20 minutes.

PMH – 3 renal transplants with only 3% renal function, not on dialysis and no recent change to urine output. She has had a parathyroidectomy 12 months ago.

Vital signs:

BP 178/104

PR 88/min

RR 22/min

GCS 15

1. What are the possible causes for her event?

Her blood results:

Na  142  mmol/l

K  3.0  mmol/l

Cl  106  mmol/l

Ca  0.54  mmol/l

HCO3  20  mmol/l

Glu  5.2  mmol/l

Urea  20.5  mmol/l

Creat  489  umol/l

Hct  0.30

Hb  102  g/l

1. Describe and interpret her results

2. What would you expect to find on her ECG?

3. How would you treat her?