An unwell lady with a history of breast cancer

A 53 year old female presents to the Queen Elizabeth Hospital, Blantyre with a 2 day history of drowsiness, diarrhoea and vomiting.

Her past medical history includes hypertension, diabetes and recently diagnosed breast cancer.

On examination she is dehydrated, BP 95/60, pulse 120/min, temp 380C, O2 sats 90% on air and Glasgow Coma Score of 14/15 (E4V4M6).

  1. What other history is required?
  2. What diagnoses would you consider?
  3. What immediate tests are indicated?
  4. What treatment would you start?


Write what you think and what you'd do


Show the answer?


Is she on chemotherapy for her breast cancer? If so you would worry about the possibility of neutropenic sepsis.  Immediate tests would include a blood sugar level (quick to do and vital in anyone with a history drowsiness – and we know she has diabetes), urgent full blood count (FBC) and blood cultures.  Less urgent tests include a chest X ray, urine dipstick (send for microscopy and culture if indicated) and urea and electrolytes.

Intravenous (IV) fluids,  IV broad spectrum antibiotics and oxygen should be started as soon as possible.

FBC results: Hb 66, WCC 0.8, Plt 34.

This case was contributed by Ewan Brown and Leo Masamba.