Chief Complaint
- 37 year old male was brought into the ED by family after being found down in his home
HPI
- Has a pulse, breathing on his own, but was unresponsive, so intubated in the ED for airway protection
- Per family, last known normal was this morning
- Unknown if recently used drugs or alcohol
PMH
- Methamphetamine Use
- Alcohol Use Disorder
- Major Depression Disorder
- Type II Diabetes
Family History
- Non-contributory
Social History
- Never smoker
- History of methamphetamine use
- Alcohol use disorder
Vitals
Temp: 37.1° C, BP: 112/64 mmHg, HR: 110 bpm, SpO2: 95% on ventilator
Ventilator Settings: Volume Control, VT 320, FiO2 0.30, PEEP 8, RR 22
Physical Exam
- Intubated and ventilated
- Remains unresponsive when sedation is weaned
Lab
- WBC 10.2, Hgb 12.4, Plt 245K
- Na+ 140, K+ 4.2, Cl– 105, HCO3– 14, BUN 14, Cr 0.8, Glucose 88
- AST: 37, ALT 25, Total Bilirubin 0.3, Albumin 3.5
- ABG: pH 6.88, PaCO2 31 mmHg, PaO2 94 mmHg
- Serum Osmolality: 305
Imaging
- CT head without contrast does not show any significant findings
What’s on your differential diagnosis?
What would you do next in the work-up for this patient?
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