A comprehensive urine drug screen showed only benzodiazepines from the midazolam. The patient also received lorazepam for agitation and midazolam for sedation before undergoing a head computed tomography scan, the results of which were normal. Tests of a sample from a lumbar puncture showed normal values for glucose, protein, and cell count, and antivirals and antibiotics were discontinued. He received both acyclovir for possible herpes encephalitis and cefotaxime until the cause of his symptoms was determined not to be sepsis. He was admitted to the pediatric intensive care unit. He was obtunded, randomly reacting to touch, but not responsive to voice. The patient was brought back to the emergency department 40 h after his initial presentation. He went to sleep, but he woke several hours later screaming, agitated, and in need of restraint in order not to hurt himself. Two hours after taking the antiemetic, he began saying things that did not make sense. At home, the patient continued to vomit everything he ate or drank, even after receiving his antiemetic medication. The patient’s symptoms were treated with intravenous fluids and an antiemetic medication. Values for electrolytes, glucose, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, calcium, and a complete blood count were all within their reference intervals. Fax 21 E-mail Case DescriptionĪ 13-year-old Hispanic male presented to the emergency department with an altered mental status (AMS) after a 4-day history of nausea and vomiting. *Children’s Medical Center, 1935 Medical District Dr., Dallas, TX 76018. Values for electrolytes, glucose, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, calcium, and a complete blood count were all within their reference intervals.ġDepartment of Pathology, University of Texas Southwestern Medical Center and 2Children’s Medical Center, Dallas, TX. A 13-year-old Hispanic male presented to the emergency department (ED)3 with an altered mental status (AMS) after a 4-day history of nausea and vomiting.
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