MSFinals-0949

MSFinals-0949

A 67-year-old woman is brought to Accident and Emergency after being found near-unconscious by her daughter. Her daughter indicates that she has a long-term joint disorder that has been controlled with oral medication and uses steroids excessively. She has recently been suffering from depression and has had poor compliance with medications. On examination, she is responsive to pain. Her pulse is 130 bpm and blood pressure is 90/60 mmHg. She is afebrile.
Basic blood investigations reveal:
Investigation Patient Normal value
Haemoglobin 121 g/l 135–175 g/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Platelets 233 × 109/l 150–400 × 109/l
Sodium (Na+) 129 mmol/l 135–145 mmol/l
Potassium (K+) 6.0 mmol/l 3.5–5.0 mmol/l
Creatinine 93 μmol/l 50–120 µmol/l
Glucose 2.7 mmol/l <11.1 mmol/l (random)
What is the most likely diagnosis?