ABSTRACT
KJ, A 21-YEAR-OLD college student, consumed multiple mixed alcoholic beverages at an off-campus party. Suddenly he became disoriented, developed slurred speech, vomited, and became unresponsive. When KJ couldn't be aroused, his friends called 9-1-1 and he was transported to the ED.KJ's friends informed the emergency medical technicians (EMTs) that because KJ had been preparing for exams, he'd been eating and sleeping less than usual for several days. Following exams and despite feeling a little "run down," KJ consumed at least two 8 oz tonic drinks mixed with 2 oz of 80-proof vodka (40% alcohol by volume) every hour for 3 consecutive hours while at the party.On arrival at the ED, KJ doesn't respond to voice commands and requires repeated noxious stimuli to open his eyes. KJ's face is covered in dried vomitus, but no blood is visible on his face and neck. Traumatic injury is ruled out based on reports from KJ's friends to the EMTs and his ED evaluation. His vital signs are as follows: rectal temperature, 95[degrees] F (35[degrees] C); heart rate, regular and rapid at 118/minute; respiratory rate, slow and irregular at 5/minute, with coarse breath sounds in his right lower lung field; BP, 80/50 supine; oxygen saturation, 90% on 100% non-rebreather mask. His pupils are 3 mm in diameter and react equally to light, and his cough reflex is intact but weak. His Glasgow Coma Scale (GCS) score on arrival to the ED is 8: E, 2 (opens eyes to pain); V, 2 (incomprehensible sounds); M, 4 (withdraws to pain). Point-of-care blood glucose is 90 mg/dL.Bedside cardiac monitoring is initiated, revealing sinus tachycardia. Peripheral venous access is established and 1 L of 0.9% sodium chloride solution is administered via I.V. bolus, followed by a maintenance infusion of 0.9% sodium chloride solution at 150 mL/hour. Blood specimens are obtained for stat lab tests, including arterial blood gas (ABG) analysis, serum chemistries, liver function panel, serum osmolality, anion gap, complete
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