She has been unwell for 2 days complaining of heavy, aching legs.
On arrival, she has a respiratory arrest and is immediately intubated and ventilated.
She had been admitted 2 years previously with a low blood sugar, hyponatraemia and vomiting and improved with fluid.
(Since the episode 2 years ago, she had become increasingly less active and saw the GP 4 weeks. A blood test showed a sodium of 125 mmol/l.)
On admission PICU she was found to have evidence of rhabdomyolysis (elevated creatinine kinase with myoglobinuria)
New Blood results
Na 113
K 7.9
Glucose< 1 mmol/l
What is the diagnosis?
What clinical sign would you look for?