Case 30-2003 - A 21-Year-Old Man with Sudden Alteration of Mental Status

doi:10.1056/NEJMcpc030021

Volume 349:1267-1275		September 25, 2003		Number 13

Case 30-2003 — A 21-Year-Old Man with Sudden Alteration of Mental Status

David N. Tancredi, M.D., and Michael W. Shannon, M.D.

Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Presentation of Case

Dr. Joshua N. Goldstein (Emergency Medicine): A 21-year-oldman was brought to the emergency department because of a suddenchange in mental status.

On the evening of admission, the patient had been consumingalcohol with friends. They noted that he had begun to act strangely,becoming uncommunicative and incontinent of urine and stool,and thought that he might have had a brief seizure. They calledan ambulance. When emergency medical services arrived, the patientwas awake but uncommunicative and unable to follow commands.The glucose level in a finger-stick blood sample was normal.An intravenous catheter was placed, and the . . . [Full Text of this Article]

Diagnosis and Management

Stabilization and Sedation

Provisional Diagnosis

Gastrointestinal Decontamination

Pathophysiology and Management of ${gamma}$ -Hydroxybutyrate Intoxication

Final Diagnosis

Source Information

From the Department of Emergency Medicine, Massachusetts General Hospital (D.N.T.); the Department of Emergency Medicine, Children's Hospital (M.W.S.); and the Departments of Medicine (D.N.T.) and Pediatrics (M.W.S.), Harvard Medical School — all in Boston.