Altered Mental Status
A 74-year-old lethargic woman is brought to the ED by her family. Her daughter states that the patient has been progressively somnolent over the last week and could not be woken up today. The patient takes medications for diabetes, hypertension, hypothyroidism and a recent ankle sprain, which is treated with a hydrocodone/acetaminophen combination. In the ED, the patient is profoundly lethargic, responsive only to pain, and has periorbital edema and delayed relaxation of the deep tendon reflexes. Her blood pressure is 145/84 mm Hg, heart rate is 56 beats per minute, temperature is 94.8°F, and respiratory rate is 12 breaths per minute. Her fingerstick glucose is 195 mg/dL. Which of the following is the most likely diagnosis?
b. Myocardial infarction
d. Myxedema coma
Please submit your answer in the "comment" section. The person with the most correct entries at the end of six weeks will receive a copy of the book PreTest Emergency Medicine.
For more information about the contest, please click here.
quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training. For more information please refer to the following link.