This is modeled after a case presented in resident report and one described in an American Family Physician 1998 article.
A man in his 20s is brought into your ER from prison because he was found seizing in his cell. He seized again in the ambulance and despite IV diazepam, he seized once more in the ER. Temperature is 38.0, pulse 105, blood pressure 170/80, respiratory rate 28. Neuro exam showed no focal abnormalities and the rest of the exam was unremarkable.
An ABG showed pH 7.03, PO2 298, PCO2 37, HCO3 9.3. Electrolytes were Na 144, Cl 104, K 3.5, CO2 10, glucose 150. CBC showed white count 18,000 (68% neutrophils). A serum and urine tox screen was negative, LFTs were normal, U/A was negative, EKG was normal. The CXR is shown below.
Upon seeing the CXR, your attending makes the diagnosis, administers one drug that reverses the seizures and corrects the metabolic acidosis.
Challenge: What's the diagnosis? What's the cure?
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