July 2018 Critical Care Case of the Month

Monday, July 2, 2018 at 8:00AM
Rick Robbins, M.D. in acidosis, alcohol, altered mental status, anion gap, diagnosis, electrolyte disturbance, fomepizole, osmolal gap, osmolality, poisoning

Stephanie Fountain, MD

Banner University Medical Center Phoenix

Phoenix, AZ USA 

History of Present Illness

A 45-year-old man was brought to the Emergency Room by his mother complaining of weakness, dizziness, and trouble swallowing. He was also incontinent of stool and looked “sunburned”.

Past Medical History

He has a past medical history of:

• Schizophrenia
• Depression
• Polysubstance abuse
• Crohn’s disease
• Type 2 diabetes
• Hyperlipidemia

Medications

• Prazosin
• Venlafaxine
• Risperidone
• Buspirone
• Oxcarbazepine
• Gabapentin
• Hydroxyzine
• Lithium
• KCL
• Metformin
• Atorvastatin
• Adalimumab
• Mesalamine
• Prednisone
• Ferrous sulfate

Physical Examination

• Vitals: 80 kg / 97.3 degrees / 101 bpm / 100% 28RR  / BP 111/72 
• The patient was toxic appearing and flushed.
• Oriented to self only, very lethargic
• Dry mucous membranes
• Lungs clear to auscultation and percussion
• Heart tachycardic but no murmurs
• Abdomen without organomegaly, masses or tenderness
• Extremities without edema

Which of the following should be done at this time? (Click on the correct answer to be directed to the second of six pages)

1. Electrolytes
2. Lumbar puncture
3. Urine drug screen
4. 1 and 3
5. All of the above

Cite as: Fountain S. July 2018 critical care case of the month. Southwest J Pulm Crit Care. 2018;17(1):7-14. doi: https://doi.org/10.13175/swjpcc085-18 PDF

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).