A 46-year-old man is found vomiting beside an open container of an automotive fluid. He has tachypnoea, flank pain and oliguria; arterial blood gas analysis shows pH 7.12 (7.35–7.45) with a high anion gap and an increased osmolal gap. His serum calcium is 1.72 mmol/L (2.10–2.60), and urine microscopy later shows numerous envelope-shaped crystals. Which one of the following is the most likely diagnosis?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Emergency and Toxicology
See allA 22-year-old man was struck on the right temple by a cricket ball three hours ago in a country town. He was briefly unconscious, then walked off the field and…
Pre-internship · middle twist
A 70 kg man requires debridement and suturing of an 18 cm laceration on his forearm in the emergency department. There is no adrenaline-containing local anaesth…
Mechanisms of disease · common
A 27-year-old man is brought in 20 minutes after his motorcycle struck a tree at speed. He is agitated, with a respiratory rate of 38/min, oxygen saturation 84%…
Clinical rotations · common
A 22-year-old woman is brought from a music festival by paramedics. She is agitated and confused, her temperature is 39.8 °C, pulse 132/min, blood pressure 158/…
Clinical rotations · middle twist
A 19-year-old woman presents six hours after taking 30 × 500 mg paracetamol tablets in a single impulsive act following an argument. She also took "a few&q…
Clinical rotations · common