Tue16November0750PM 5

A 20-year-old student is found in her bedroom by friends drowsy, confused and sweating. She is unable to give a clear history.

On examination she has a fever of 38.3°C, pulse 110 bpm, BP 110/60 mmHg and she appears short of breath with a respiratory rate of 30. there is no neck stiffness. Her chest sounds clear to auscultation.

Arterial blood gas result taken on 15 l/min oxygen shows:

pH 7.29 (7.35-7.45)

Pa O2 37 kPa (11-14)

PaCO2 2.1 kPa (4.5-6)

Lactate 2.4 mmol/L (0.1-2.5)

Which of the following is the most likely diagnosis?

(Please select 1 option)

Meningitis

Legionella pneumonia

Cocaine use

Aspirin overdose Correct

Severe asthma

Explanation

There are a number of clues here that point to aspirin toxicity:

fever

sweating

tachypnoea, and

acidosis.

The presence of confusion suggests a severe overdose.

In severe asthma and Legionella pneumonia hypoxia would be expected.

Answer Statistics

1

17%

2

2%

3

21%

4

62%

5

1%

Times answered: 266