Case 11-2012: A 60-year-old man with weakness, rash, and renal failure

摘要

The patient was in his usual state of health until several days before admission, when fatigue and myalgias reportedly developed, associated with markedly decreased activity. Three days before admission, he reportedly lay down on the floor of his home and moved very little or not at all for the next 3 days, without oral intake. On the morning of admission, he was incontinent of urine and his speech was incomprehensible. Emergency medical services personnel were called; they found the patient easily aroused with verbal stimulation and appearing weak and short of breath, with inappropriate verbal responses. The blood pressure was 110/68 mm Hg, the pulse 100 beats per minute, and the respiratory rate 24 breaths per minute. The skin was pale, cold, and dry. The patient moved all extremities and obeyed commands. The neck was immobilized. Oxygen (10 liters) was administered through a nonrebreather face mask; oxygen saturation ranged from 68 to 88%. A glucose level measured with a fingerstick device was 46 mg per deciliter (2.6 mmol per liter), and an ampule of glucose, 25 g, was administered. The patient's responsiveness improved; additional glucose and 2 liters of intravenous fluids were given, and he was transported to another hospital.