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Author: Patrick M. Brown, MSIV
Western University of Health Sciences College of Osteopathic Medicine of the Pacific
An otherwise healthy 25 year old male is brought to the emergency department (ED) by emergency medical services (EMS) after witnesses saw him collapse while hiking in Arizona on a humid 38.3°C (101°F) summer day. His friends state that he was feeling well and behaving normally before hiking and add that they found his full water bottle in the car on the way to the ED. On physical exam, his temperature is 40.6°C (105.2°F), pulse is 134, blood pressure is 82/60, O2 saturation is 88% on room air and respirations are 21 breaths/min and labored. BMI is 29.3. He currently is unable to answer questions appropriately and appears restless. He is diaphoretic and hot to the touch. Eye exam reveals pupils that are 3mm and reactive to light bilaterally. Crackles are heard bilaterally on lung auscultation. Neurological exam reveals no abnormalities in tone or reflexes and the neck is supple. There are no obvious signs of trauma. His friends state that he is a regular smoker, social drinker and smokes marijuana recreationally. Labs significant for hemoglobin of 17.2, hematocrit of 51.0, WBC of 16.9, BUN of 43, creatinine of 0.9, and 2+ ketones in urine.