A 53 year old woman presents with a 2 day history of drowsiness, diarrhoea and vomiting.
Her past medical history includes hypertension, diabetes, and recently diagnosed breast cancer.
On examination she is dehydrated, BP 95/60, pulse 120/min, temp 38°C, O2 sats 90% on air, and Glasgow Coma Score of 14/15 (E4V4M6).
- What other history is required?
- What immediate tests are indicated?
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Further information
She has had some medicines but the family doesn’t know what and there are no records. Diagnostic resources are limited as this presentation was to the Queen Elizabeth Hospital, Blantyre, Malawi
- FBC results: Hb 66, WCC 0.8, Plt 34.
- A rapid malaria test is negative
This case was contributed by Ewan Brown and Leo Masamba.
Questions
- Are there any more urgent tests that you should do?
- What diagnoses would you consider?
- What treatment would you start?
What the receiving doctors thought
- Immediate tests must include a blood sugar level (quick to do and vital in anyone with a history drowsiness – and we know she has diabetes),
- Urgent full blood count (FBC) revealed severe neutropenia. Neutropenic sepsis is a major worry, but you would have to think of sending the blood count to know.
- Less urgent tests include a chest X ray, urine dipstick (send for microscopy and culture if indicated) and urea and electrolytes.
- Intravenous (IV) fluids, IV broad spectrum antibiotics and oxygen should be started as soon as possible.
Further info
Last Updated on February 2, 2025 by admin