title: Altered mental status in the emergency department - Can an electrocardiogram show the right way to go?
abstract: A 38-year-old African American male patient with a past medical history of human immunodeficiency virus and schizophrenia who was noncompliant with medications presented to the emergency department (ED) after activation of the local crisis response center for altered mental status. Upon arrival he was lethargic and uncooperative, unable to provide any significant details apart from pleuritic chest pain. His blood pressure was 133/88 mmHg, heart rate 43 beats per minute and initial body temperature 36.1 °C which prompted an electrocardiogram (EKG). This initial EKG was compared to a prior one obtained six months earlier during an ER visit for an acute psychotic episode. Three hours of being admitted he started shivering. Patient was found to be hypothermic with a rectal temperature of 28.9 °C. He was also hypoglycemic, pancytopenic and had positive urine cultures with >100,000 CFU/ml coagulase-negative Staphylococcus. There was no evidence of medication overdose. His CT scan of the brain did not show evidence of intracranial bleeding and his serum calcium was normal.
authors.affiliation: Einstein Medical Center, Department of Cardiology, Philadelphia, PA; Western Connecticut Health Network, Danbury, CT, USA. Electronic address: andremacdias@gmail.com.
authors.forename: Andre
authors.initials: A
authors.lastname: Dias
authors.affiliation: Einstein Medical Center, Department of Cardiology, Philadelphia, PA; Western Connecticut Health Network, Danbury, CT, USA.
authors.forename: Emiliana
authors.initials: E
authors.lastname: Franco
authors.affiliation: Einstein Medical Center, Department of Cardiology, Philadelphia, PA.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Martinez
authors.affiliation: Einstein Medical Center, Department of Cardiology, Philadelphia, PA; Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Figueredo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D007035:Hypothermia / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis*; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000209:etiology*
keywords: Altered mental status; Electrocardiography