Altered mental status

Adrenal Insufficiency With Hypoglycemia in a Medically Complex Pediatric Patient

Medically complex children present a low frequency but often high acuity patient population for emergency medical services (EMS) personnel. We present a case of a 12-year-old male with Duchenne muscular dystrophy and adrenal agenesis found unresponsive. Detailed history-taking was crucial for diagnostic accuracy and this patient's favorable outcome. This case highlights the importance of recognizing adrenal insufficiency-induced hypoglycemia in patients presenting with altered mental status. EMS personnel should be trained to identify and manage adrenal insufficiency, using detailed histories and on-scene medical oversight to improve outcomes.

Postoperative Altered Mental Status: A Case Report and Diagnostic Dilemma

Postoperative altered mental status (AMS) is a prevalent and complex issue that poses a significant diagnostic challenge in the clinical setting. Clinical presentation consists of cognitive disturbances that can range from mild confusion to coma. Given the complexity and variability of AMS, each patient requires a careful and thorough evaluation to identify the underlying cause. Thus, we present a case of a 57-year-old male with confirmed left knee septic arthritis, whose admission was complicated by AMS following several incision and drainage procedures. We highlight the importance of considering a broad differential diagnosis when evaluating postoperative AMS, including electrolyte disturbances and systemic conditions. The case also discusses the importance of early recognition, interdisciplinary collaboration, and a comprehensive diagnostic strategy. By adopting a comprehensive and collaborative approach, healthcare providers can optimize patient outcomes and minimize complications in postoperative AMS cases. The patient's AMS was ultimately attributed to a combination of metabolic disturbances, drug-related factors, and systemic conditions. His severe psychiatric symptoms were successfully managed with targeted pharmacologic interventions.