New England Journal of Medicine 2015-01-29

Case records of the Massachusetts General Hospital. Case 4-2015. A 49-year-old man with obtundation followed by agitation and acidosis.

Cynthia M Cooper, Jason M Baron

Index: N. Engl. J. Med. 372(5) , 465-73, (2015)

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Abstract

A 49-year-old man was admitted to this hospital after being found unresponsive outdoors; he was next to a half-filled bottle of cloudy liquid with pill fragments. An electrocardiogram showed a QTc interval of 501 msec. A diagnostic test was performed. Presentation of Case Dr. Meredith Eicken (Medicine–Pediatrics): A 49-year-old man was admitted to this hospital after being found outdoors in early autumn with obtundation, followed by increasing agitation. On the afternoon of admission, the patient was found leaning up against a wall, unresponsive. With him was a half-filled bottle of cloudy liquid with possible pill fragments, as well as bottles of prescription medications that had been filled earlier that day, including trazodone (1 of 28 pills remaining) and risperidone, buspirone, and loratadine (each with all pills present). Emergency medical services were called. On examination of the patient in the field, . . .