Comatose patient with asymmetric septal hypertrophy
A patient in their 70s with a history of schizophrenia, hypothyroidism and poor compliance to medication was brought in by ambulance with confusion, agitation and hypothermia. Glasgow Coma Scale (GCS) was 7 (E1V2M4). Neurological examination, imaging and toxicology were normal. There was extensive periorbital swelling. Observations found heart rate 38 bpm, blood pressure 140/63, temperature 35.1°C and 22 respirations/min saturating 97% on room air. There was no source of infection, white cell count 5.43×109/L and c-reactive protein 7 mg/L. We found a mixed respiratory and metabolic acidosis (pH 7.19, anion gap 19.6 mmol/L, lactate 2.6 mmol/L, pC02 8.26 kPa, bicarbonate 18.5 mmol/L). They were admitted to the intensive care unit, and GCS did not normalise on the …
