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Cane toads and bush tucker: starvation ketoacidosis in a bushwalker
Author(s) -
Wongseelashote Sarah,
Quilty Simon,
JohnstonLeek Malcolm
Publication year - 2013
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja13.10204
Subject(s) - darwin (adl) , general hospital , medicine , history , genealogy , management , library science , family medicine , engineering , systems engineering , computer science , economics
Clinical record An otherwise fit and healthy 35-year-old woman presented to our emergency department at a remote Northern Territory hospital with vomiting and abdominal pain. An independent traveller from a southern Australian city, she had embarked 10 days earlier on a solo bushwalk into an isolated national park with the intention of living on “bush tucker” — wild plants, berries and native animals that she would find along the way. She had not sought any advice from authorities or local people before commencing her bushwalk. She followed the path of a river from which she drank fresh water throughout her journey. By Day 4 she had completely consumed her small supply of food and began eating berries that she identified using a popular Australian pictorial guide. 1 On Day 6, being extremely hungry, she ate a frog that leapt into her tent, which she subsequently grilled over a spirit flame. She immediately developed nausea and vomiting and became acutely aware of the distance to medical care and her serious predicament. Still vomiting intermittently and without any food, she embarked on a 4-day march that we estimate to be around 100 kilometres to a campsite with a public telephone, where she called an ambulance. On arrival at the hospital she was diaphoretic, nauseated and anxious. She had sunburn on exposed areas and had multiple insect bites and abrasions. Apart from a respiratory rate of 26 breaths/min, her vital signs were normal and the only abnormality on physical examination was mild epigastric tenderness. Initial venous blood gas examination showed severe metabolic acidosis with respiratory compensation (Box). Electrolytes, renal function, liver function and creatine kinase were all within normal limits, as was an electrocardiogram. She received 2 L of intravenous normal saline and a sandwich, and her symptoms rapidly improved. She was admitted and given breakfast, lunch and dinner. Eight hours later, her pH had normalised and the following day she was discharged.