A 26-Year-Old Man Who Passed Out at His Work Desk

Craig A. Goolsby, MD

Disclosures

May 24, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

Paramedics bring a 26-year-old man to the emergency department (ED) with an acute onset of altered mental status. The paramedics had picked up the patient at his place of employment. His coworkers reported that he was acting normally when he arrived at work at 9 am; however, at about noon, a colleague noticed the patient slumping in his chair. He was minimally responsive and had an open, unlabeled pillbox on his desk.

The coworkers were aware of the patient's history of chronic back pain, but nothing more. They also reported some recent disciplinary problems at work. He arrives obtunded and is unable to answer any questions or provide any additional history. He is not wearing any medical alert bracelets. The paramedics have brought the pillbox, which contains several types of pills in various amounts.

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