Altered Mental Status 275264.A 67-year-old man presents to the ED for worsening confusion. His
wife states that he received his first dose of chemotherapy for lung cancer
2 days ago. Over the last 24 hours, the patient became confused. His BP is
130/70 mm Hg, HR is 87 beats per minute, and temperature is 98.9°F.
While in the ED, the patient seizes. You administer an antiepileptic and the
seizure immediately stops. You compare his current electrolyte panel to
one taken 2 days ago.
Two days ago TodaySodium (mEq/L) 139 113
Potassium (mEq/L) 4.1 3.9
Chloride (mEq/L) 105 98
Bicarbonate (mEq/L) 23 20
BUN (mg/dL) 13 17
Creatinine (mg/dL) 0.4 0.7
Glucose (mg/dL) 98 92Which of the following is the most appropriate treatment?
a. 0.45% saline
b. 0.9% saline
c. 3% saline
d. 5% dextrose
e. 50% dextrose
265.A 31-year-old woman with a history of schizophrenia presents to the
ED for altered mental status. A friend states that the patient is on multiple
medications for her schizophrenia. Her BP is 150/80 mm Hg, HR 121 beats
per minute, RR 20 breaths per minute, and temperature 104.5°F. On exam-
ination, the patient is diaphoretic with distinctive “lead-pipe” rigidity of her
musculature. You believe the patient has neuroleptic malignant syndrome.
After basic stabilizing measures, which of the following medications is most
appropriate to administer?
a. Haloperidol
b. Droperidol
c. Dantrolene
d. Diphenhydramine
e. Acetaminophen