An 83-year-old woman presents to the emergency department with altered mental status. The family states that she has been having increasing problems with her memory over the last several months. The daughter found her in her room when she didn’t come down for breakfast. Her blood pressure prescription is missing seven more tablets of clonidine than it should. PMH : Hypertension Physical examination T : 96.4°F HR : 60 bpm RR : 9 breaths per minute BP : 80/40 mm Hg General : Confused and somnolent HEENT : Miosis.
Pulmonary : Clear to auscultation CV : Bradycardic without murmur Abdomen : Soft and nontender Neurologic : Cranial nerves II-XII intact. Hyporeflexic. Muscle strength is markedly decreased. What is the likely diagnosis and what should be the next step? (Answer is posted in the comment section below!) *This case is from the Docplexus editorial team for educative purposes…
