Approach to altered mental status Quiz: Ace Your Exams
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A 72-year-old woman is brought to the emergency department by her daughter due to confusion and lethargy for the past two days. The patient has recently been telling her daughter that she has been nauseous with a metallic taste in the mouth. She has chronic kidney disease secondary to hypertension and diabetes mellitus. She has not had any recent falls or head trauma. Temperature is 37.0 °C (98.6 °F), pulse is 90/min, respiratory rate is 22/min, blood pressure is 168/90 mmHg, and oxygen saturation is 90% on room air. The patient is disoriented to time and place. On examination, there is periorbital and peripheral edema, dry mucous membranes, and dry skin with bilateral upper extremity excoriations. Lung auscultation reveals bibasilar crackles. There is mild diffuse abdominal tenderness to palpation. Laboratory results are shown below. Which of the following additional historical features is most likely in this patient?
| Laboratory Test | Result |
| Potassium | 6.2 mEq/L |
| Creatinine | 6.5 mg/dL (Baseline 2.0 mg/dL) |
| Blood Urea Nitrogen (BUN) | 98 mg/dL |
| Bicarbonate | 15 mEq/L |
| Blood glucose | 86 (mg/dL) |
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