A 20 year old male presents to the Emergency Department with confusion and abdominal pain. On arrival he is disorientated, confused and is unable to recollect his name or date of birth.

He appears to have moderate abdominal discomfort but is unable to provide any further history. You can smell alcohol on his breath. He does not have a medic-alert bracelet or pendant on. He does not have anyone with him in hospital who can provide a history.

On Examination

  • Obs: Temp 37.9, BP 80/40, HR 122, RR 24, SpO2 100% on air

  • CVS: Unremarkable bar observations

  • Respiratory: Unremarkable bar observations

  • Abdominal: General tenderness around the umbilicus but no guarding or peritonism. No abdominal swelling and bowel sounds are normal. Mouth appears dry.

  • Neurological: GCS 14/15. Pupils equal and reactive to light. No focal neurological deficit seen.

  • A BM stick show a plasma glucose of 32.


Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. How would you further assess this patient and give details of the steps you would take?   

  2. What specific investigations would you want to perform to confirm the most likely diagnosis?

  3. What would you most likely see on a blood gas analysis and why?

  4. What precipitants are there to this particular condition (the most likely diagnosis)?

  5. How would you manage this patient when the diagnosis is made?

  6. What causes mortality in these cases?

  7. When would you refer these cases to ITU?