[Expert Solution]: A 25-year-old Caucasian male with an…

A 25-year-old Caucasian male with an unknown history is brought into the Tulane Hospital Emergency Department after an unrelated individual called EMS. Not much is known about the patient other than a loose report that he was wandering down a busy street as if he were inebriated. Per the report from EMS, the patient was reported to display slurred speech and could not walk in a straight line; of note, when EMS arrived to his location, he was sitting on the sidewalk pointing to an empty chocolate bar wrapper. He did not have viable identification on his person. Upon initial examination, he did not respond to questions appropriately, muttering incoherently with each response. He was found to have dilated pupils and was profoundly diaphoretic (sweating). His preliminary vitals were revealing of a blood pressure of 94/68, heart rate 150, respiratory rate of 28, and oxygen saturation of 92% on room air; physical examination was revealing of significant tachycardia with no appreciable murmurs, diffuse abdominal pain with palpation, a large ecchymosis (bruise) on his left lower extremity, and multiple puncture marks on his abdomen. Laboratory examination revealed the following pertinent positives: CBC → hemoglobin of 10.5, platelets 475,000 CMP (comprehensive metabolic panel): Sodium 132, potassium 3.3, Chloride 93, bicarbonate 18, BUN (blood urea nitrogen) 34, Creatinine 3.4; hepatic transaminases (AST, ALT, GGT) slightly elevated. The nurse caring for the patient is in the middle of performing a blood glucose test given that the glucose parameter for the CMP was undetectable. Given the presentation above, what syndromes/diseases would be in the differential diagnosis? Consider the anion gap when answering this question. How do you calculate the anion gap? If the glucometer testing was revealing of a blood glucose of 1200, what diagnosis should be considered to be primary? Given your answer for 3, are there any metabolite(s) which could be driving this patient’s disease process? In addition to glucose, which electrolyte should be closely monitored? Why?