An iatrogenic metabolic encephalopathy in a nonagenarian: The dilemma of a critical miss as a possible social dismissal.
Here we posit for discussion the example of a reversible metabolic encephalopthy in a very elderly male that was missed clinically. A metabolic encephalopathy in extrememly elderly patients may be confused with delerium or inattention. A reversible cause of cognative dysfunction in the aged may be missed by practitioners because the aged may be assumed to have some level of impaired cognition; this may lead to a "social dismissal" of mental status changes. We highlight the need for engaged physicians in the care of the aged and vigilance against a professional bias toward the elderly patient that is dismissive.
Department of Anesthesiology, Division of Critical Care, Critical Care and Burn, The Ohio State University Medical Center, 410 West 10 Avenue, Columbus, Ohio 43210, USA.
Ravi S
RS
Tripathi
Department of Anesthesiology, Division of Critical Care, Critical Care and Burn, The Ohio State University Medical Center, 410 West 10 Avenue, Columbus, Ohio 43210, USA.
Sarah B
SB
Russell
Department of Anesthesiology, Division of Critical Care, Critical Care and Burn, The Ohio State University Medical Center, 410 West 10 Avenue, Columbus, Ohio 43210, USA.
Michael R
MR
Lyaker
Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Medical Center, 410 West 10 Avenue, Columbus, Ohio 43210, USA.
Stanislaw Pa
SP
Stawicki
Department of Anesthesiology, Division of Critical Care, Critical Care and Burn, The Ohio State University Medical Center, 410 West 10 Avenue, Columbus, Ohio 43210, USA.
Thomas J
TJ
Papadimos
Aging; critical care; encephalopathy; ethics; palliation