An Unresponsive 38-Year-Old Man

Lars Grimm, MD, MHS; Malkeet Gupta, MS, MD; Joshua M. Kosowsky, MD

Disclosures

March 15, 2016

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 accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 38-year-old man with altered mental status is brought to the emergency department (ED) by ambulance. The patient had been found sprawled on the stoop of an apartment building when residents called the police. He was unresponsive when the paramedics arrived, and they were unable to obtain any additional history from the patient or from the onlookers at the scene.

The patient was wrapped in blankets and an intravenous line was inserted, which provided 0.5 L of normal saline during transit to the ED. When the patient was found, the temperature outside was about 35°F, with winds reaching speeds of 10-15 mi/hr.

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