A 35 year old male patient hailing from rural background from low SES was admitted with a diagnosis of disorganized schizophrenia and comorbid cannabis use (in harmful use). He was started on olanzapine 5mg which was increased to 20mg within 2 weeks. Considering his florid psychotic symps, bilateral modified ECT was also started for last 2 weeks, the last ECT recieved day before yesterday. From yesterday he was found to have profuse vomiting (3-4 times) whilst his indoor stay and on-duty sister reported an episode of GTCS. He was quickly attended with inj lorazepam.
Capillary blood glucose was 172mg/dl & serum Na & K came out to be 110 and 3 meq/lt respectively. On examination, he was confused, disoriented and clearly delirious (hyperactive delirium) with occasional urinary incontinence. GCS score was 7. Chest & abdomen exam WNL while CNS exam revealed an indeterminate plantar response…
