A 35-year-old woman with bipolar disorder presented to the emergency with hypercapnic respiratory failure. Home medications included oxycodone/acetaminophen for chronic muscle and joint pain and venlafaxine, etizolam, and lamotrigine for her chronic psychiatric disorder,not known NIDDM/HTN or thyroid disorder ,nonsmoker and social drinker only .
She was last seen normal the prior night by her ex-husband & her house maid found her on the couch in morning , obtunded, bradypneic, and in pale condition and brought her to hospital with the help of neighbors , in emergency ward SpO2 85%, blood pressure 116/79 mm Hg, heart rate 98 beats per minute, and normothermic. Neurological examination revealed ,conscious but drowsy,responding to verbral command , slurring of speech,occasional irrelevent talk but no aphasia, overall GCS 12-13, the patient also had h/o acute hearing loss rt >lt…
