St. Patrick, the organic chemist and Sherlock Holmes meet in the emergency department: a case report.

A 29-year-old male presented to the Royal Alexandra Hospital ED on the evening of St. Patrick’s day in 2001. His presenting complaint was general malaise, and he was well known to the department for a variety of previous mixed ingestions and minor injuries. His history was significant for alcohol abuse, with the last ethanol ingestion approximately 18 hours earlier. He was a disheveled man who appeared his stated age, with a resting tachycardia of 115 beats/min, a Glasgow Coma Scale (GCS) score of 15, and a mild resting tremor. His vital signs were otherwise normal, and the physical exam did not suggest any specific toxidromes. The diagnosis of alcohol withdrawal was made, and the patient was treated with IV thiamine, B12, and dextrose-normal saline solution. The 2200 h laboratory results were as follows (normal ranges in brackets).