The next case is a 70 year old male who was admitted with a 1 day history of headache followed by a grand mal seizure. During the seizure he sustained a fracture to the neck of the left humerus. He gave a clear and articulate history to the house officer in the Accident and Emergency department when he was brought in, but could not recall anything about how he fractured his humerus. He admitted still feeling 'a bit woozy'. On admission, his pulse was 90 beats per minute, and his blood pressure was 100/60. His fracture was treated with a collar, he was admitted to the ward and kept in overnight for observation.

The next morning, the patient has deteriorated, and was quite unresponsive to questioning. His blood pressure on the ward round was 95/50, and bloods taken the previous night came back with a raised white cell count at 23.2 (normal range 4-11 x10^9/l), and a haemoglobin of 12.2. (normal range 14.0-17.6 g/dl). The patient was started on IV fluids and was catheterised.

The patient was drifting in and out of consciousness and his blood pressure had dropped to 80/40. On the ward round the consultant thought he could hear crepitations at the bases of both lungs. More biochemical tests showed a urea of 15.7 (normal 2.5-6.7 mmol/l), creatinine of 236 (normal 70-150mmol/l), and a potassium of 5.2 (normal 3.5-5 mmol/l).

The next day the patient's blood pressure had dropped to 75/35. His white cell count was 9.8, and his haemoglobin was 8.5. Despite further emergency treatment, the patient deteriorated and died.

Past medical history