Lethargy and Seizures in a 52-Year-Old Male

Abstract

Patient: 52-year-old Caucasian male. Chief Complaint: Increasing fatigue and weakness. History of Present Illness: Our patient presented for evaluation of an acute worsening of progressive weakness over the past month. He felt so weak that he almost “passed out.” He also reported an increased fluid intake and an increase in urinary output. There was no pain on urination or history of urinary tract infection. He denied chest pain, vision problems, nausea, diarrhea, and syncope. Family members were concerned that the patient was “wobbly” when he walked. While waiting in the emergency room, the patient experienced 2 tonic-clonic seizures. Past Medical History: Nephrolithiasis, hypertension, benign prostatic hypertrophy. Medication History: Lisinopril, potassium, Allopurinol, Flexeril. Social History: Denies alcohol and tobacco use. Physical Exam Findings: Blood pressure, 71/36 mm Hg; pulse, 115; respiratory rate, 22; and temperature, 36.9°C. The patient was awake and responsive but not oriented. The skin was dry and turgor was poor. The oral mucosa was also dry. The abdominal exam revealed mid-epigastric tenderness. Neurologic exam was nonfocal. Lung and cardiac exams were normal. Principal Laboratory Findings: Tables 1, 2, 3, 4 , and 5 . 1. What are this patient’s most striking clinical and laboratory test findings? 2. How do you explain these findings? 3. What is your differential diagnosis? 4. What additional laboratory test would be useful in confirming the diagnosis of this patient’s condition? 5. What laboratory tests might explain the precipitating event which caused this patient’s condition? 6. What is the most likely diagnosis? 7. What is the treatment and management of this disorder? 1. This patient has several important critical signs and symptoms that include seizure, lethargy, polydipsia, polyuria, hypotension, epigastric pain, and tachycardia. The …