MRCP2-0698

MRCP2-0698

A 49-year-old Lithuanian man is brought to the Emergency Department by two of his friends. He is confused and aggressive and walks with an unsteady gait. History is difficult to obtain from the patient due to slurring of his speech and a slight language barrier. You note that he fails to meet your gaze when you are talking to him.

Examination shows a GCS of 15/15 but he is drowsy and irritable. There is a vague smell of alcohol on his breath. He is flushed in the face and his eyes are red and hyperaemic. Pupils are slow to react to direct light but equal in size. The cardiorespiratory examination is unremarkable aside from a respiratory rate of only 8/min but SpO2 is 98% on air. The abdomen is soft and non-tender with no hepatomegaly and no signs of chronic liver disease. Despite the department being well lit, he asks you to turn the lights on.

Biochemistry reveals:

Haemoglobin 149 g/L Sodium 150 mmol/L pH 7.25
White cells 8.9×109/L Potassium 5.9mmol/L pC02 3.9kPa
Neutrophils 5.9×109/L Urea 13.8 mmol/L pO2 12.6kPa (air)
Platelets 229×109/L Creatinine 156 mol/L HCO3- 12.5 mmol/L
Prothrombin time 11 sec Glucose 24.7mmol/L BE -13.2mEq/L
Ethanol 110 mg/dL Chloride 100 mmol/L Lactate 2.0mmol/L
Anion gap 38 Osmolar gap 25 (-10 to +15)

What is the most appropriate next step in the management of this patient?