A 10 year-old boy with a history of enuresis was BIBA to the ED after a first episode generalized tonic-clonic convulsion. He seemed tired in the morning but still attended his inter-school sports competition. While getting ready to compete he collapsed and had a self-limiting seizure (5 minutes duration).
He was afebrile and had GCS 13 (E3 V4 M6) (fluctuating) for about 4 hours without improvement. Pupils were equal and reactive and he had no focal neurological deficits. He vomited 5 times during this time but was clinically euvolemic. His CT head was normal.
He had the following laboratory test results:
PH 7.37
PCO2 42
HCO3 24
Cl 96
Na 124
K 4.1
Glucose 7.1
Lactate 2.7
Questions ;
- what are the main lab abnormalities and how do they relate to above clinical presentation ?
Patient gets initial treatment in ED and gets admitted to ward. His other investigations come back as below:
Serum cortisol 1100 NM (60-420)
TFTs were normal
Osmolality plasma 265 mmol/kg L (275-295)
Spot urine sodium 209 mM
Spot urine osmolality 681 mmol/kg (50-1200)
2. what do these test results suggest?
3 . What is the underlying cause in this case?