He presented to the emergency department of this hospital. Two years earlier, the patient had had an episode of drooping and decreased sensation of the left side of the face and difficulty enunciating words, which occurred while he was at work. The patient had last eaten approximately 7 hours before presentation to the emergency department. On a typical day, he had breakfast at 5 a.m., a second breakfast at 10 a.m., lunch at 1 p.m., dinner at 6 p.m., and a snack at 8 p.m. He reported no recent illness, depression, anxiety, change in activity or exercise, or change in intake of food or drink. Review of symptoms was notable for unintentional weight gain of one pant size during the past 3 months, as well as intermittent morning dizziness during the past 3 years, which would resolve after the patient ate candy or breakfast. The altered mental status had resolved, but he could not recall most events of the morning, including the meeting that had taken place 3 hours before admission. That morning, he had felt that he was in a “dreamlike” state there were no other symptoms. The patient’s mental status improved, and he was able to provide additional history. Additional intravenous dextrose was administered, and a dextrose infusion was started. On arrival at the emergency department, the patient was obtunded and did not react to sternal rub. Intravenous dextrose was administered, and the patient was brought to the emergency department of this hospital for further evaluation. On evaluation, a fingerstick glucose measurement was 39 mg per deciliter (2.2 mmol per liter reference range, 70 to 109 mg per deciliter ). His eyes were open, but he was obtunded and making nonpurposeful movements.
Two hours before this admission, the patient was found by colleagues on the floor of a conference room.
When his mobile telephone rang, he allowed it to continue ringing. Instead, he was fidgeting and mumbling as though talking to another person. During a meeting, his colleagues noticed that he was not paying attention or participating in the conversation, which was atypical of the patient. The patient had been well until 3 hours before this admission, when altered mental status developed while he was at work. Mollie Sands (Medicine): A 49-year-old man was admitted to this hospital because of hypoglycemia. The most trusted, influential source of new medical knowledge and clinical best practices in the world.ĭr. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident.
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