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PATIENT PRESENTATION

Chief Complaint

“My dad has been complaining of headaches and is now acting confused.”

History of Present Illness

JK is a 68-year-old male, who was brought to the emergency department with a headache, nausea, and episodic vomiting that started about a week ago, and recent onset of dizziness, confusion, and irritability that was noticed today by his son while visiting with him for breakfast. He has a fever (101.3°F) of unknown duration. “A recent 4th generation HIV Ag-Ab test was negative.” His son states that JK lives alone and started complaining of not feeling well about a week ago.

Past Medical History

Type 2 diabetes, controlled with medications

Surgical History

Appendectomy 20 years ago

Family History

Father had lung cancer and passed away 40 years ago; mother had HTN and passed away from stroke 15 years ago; no siblings

Social History

He is a retired salesperson, widowed (wife passed away from metastatic breast cancer 10 years ago), who lives alone. He has one son who visits him regularly. His hobby is golf and tending to a pet cockatoo; never smoked, but drinks alcohol occasionally

Allergies

NKDA

Home Medications

Metformin (Glucophage XR®) 2000 mg PO daily with evening meal

Multivitamin 1 tablet daily

Physical Examination

Vital Signs

Temp 101.3°F, pulse 70, RR 20 breaths per minute, BP 130/92 mm Hg, pO2 92%, Ht 5′9″, 70 kg

General

Lethargic, irritable gentleman with dizziness and confusion in moderate distress

HEENT

Normocephalic, PERRLA, EOMI, (–) papilledema, photophobia, or blurred vision

Pulmonary

Diminished breath sounds

Cardiovascular

NSR, no m/r/g

Abdomen

Soft, non-distended, non-tender, bowel sounds hyperactive

Genitourinary

No complaints

Neurology

Lethargic, oriented to place and person, (–) Brudzinski’s sign, (–) Kernig’s sign, (–) nuchal rigidity

Extremities

Normal

Back

Tenderness to palpation on lower lumbar region

Laboratory Findings

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Na = 139 mmol/L

Hgb = 13.5 g/dL

Ca = 9.2 mg/dL

CK = 2.0 ng/mL

K = 4.2 mmol/L

Hct = 40%

Mg = 2.2 mg/dL

T Bili = 1.8 mg/dL

Cl = 100 mmol/L

Plt = 227

Phos = 4.4 mg/dL

Chol = 190 mg/dL

CO...

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