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 that you would like to suggest for a future Case Challenge, please contact us.
A 45-year-old man with a history of bipolar disorder, hypertension, hyperlipidemia, and asthma is transported to the emergency department after his sister found him crawling on the floor of his home, confused and incontinent. She reports that she talked with him 3 days earlier on the phone and that he sounded slightly confused at the time. She called again today, and when he failed to answer, she stopped at his home and found him delirious and unable to walk, which prompted her to call emergency services.
His medications include lithium carbonate (1200 mg/d), amlodipine (10 mg/d), atorvastatin (10 mg/d), and an albuterol rescue inhaler as needed. He is a former smoker who quit 20 years ago. He drinks alcohol socially and does not use illicit drugs.
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Cite this: Ryan J. Cole, Christopher P. Holstege. Delirious, Incontinent 45-Year-Old Found Crawling on the Floor - Medscape - Sep 01, 2022.