A 20 year old man was brought into the casualty department following repeated ‘convulsions’. He has recently lost his girlfriend and has been depressed. There was no further history available.

On examination he was found to be alert and obeying commands and was observed to go into spasms. His muscle tone was increased and was rigid. His back was arched back wards and he had a fixed smile resembling risus sardonicus. His temperature was 38C and he was tachycardic. He was breathing at 35 breaths per minute. He has passed only a small volume of red/brown urine.

1. What is your differential diagnosis?
2. What investigations should be carried out?
3. What complications have developed?
4. How do you treat him?
5. What are the potential complications?

A few later his muscle spasms worsened and he was noted to have shallow breathing.

1. What is your management?