Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Mental status changes, Metabolic encephalopathy, Pain, Peripheral swelling, Posterior reversible encephalopathy syndrome
Clinical narrative: ED note from RN 1/7/22 at 1048: "EMS TIMEOUT COMPLETED:   Pt brought in at mothers request due to alcohol abuse. Call was originally made for cardiac arrest upon arrival pt was not in CA but vomiting profusely. Pt requesting detox per mothers urging.    When asked why he was brought is pt reports "I think I had a seizure this morning due to alcohol withdrawal." Reports last drink as 1 glass of wine this morning. Pt AOx4, diaphoretic, tachycardic, hypertensive, and tachypnic in triage.   Pt was seen in ER last night for same situation but was discharged per patient"  ED notes from Dr. 1/7/22 at 1100: "Chief Complaint:  Seizure   HISTORY OF PRESENT ILLNESS   Patient is a 33 y.o. male who presents to the Emergency Department complaining of his mom witnessed him having a seizure at home this morning. Patient reports that he woke up with abrasions on his left hand and had bit his tongue and has severe constant pain in his right shoulder with limited movement and increased pain with movement. Patient states that his mom was unsure of how long it lasted. Patient reports that this is the first occurrence of a seizure. Patient reports that his last alcoholic drink was around 07:00 this morning and had one glass of wine. Patient reports having an episode of emesis earlier today. Patient also reports shakiness, lightheaded, generalized weakness, difficulty breathing,  and headache (was present prior to the seizure).  Patient denies using illegal drugs. Patient reports that he was here yesterday looking for detox placement and does not remember what happened but his disposition was marked as AMA. Patient's tetanus is up-to-date. Patient denies nausea, chest pain, abdominal pain, diarrhea, hematuria, hematochezia, measured fever, chills, vision loss, difficulty swallowing/speaking, and lower extremity pain or swelling."  H&P note from Dr. 1/7/22 at 1610: "Chief Complaint:  In the hallway in the emergency room.  Patient is sleeping.  Upon awakening patient is alert and oriented x3.  Cannot remember he fell or had seizure.  States his drinking areas from day-to-day.  Sign out AMA yesterday.  Patient promises  today he will not sign out AMA.     HPI: Patient is a 33 y.o. male who presents to the Emergency Department complaining of withdrawal onset 2 hours ago prior to arrival. Patient reports that his mom witnessed him having a seizure at home. Patient reports that he woke up with abrasions on his hands and had bit his tongue. Patient states that his mom was unsure of how long it lasted for. Patient reports that this is the first occurrence of the seizure. Patient reports that his last drink was around 07:00 this morning and had one glass of wine. Patient reports having an episode of emesis earlier today. Patient also reports shakiness, lightheaded, difficulty breathing, shortness of breath, shoulder pain, headache, and extremity swelling. Patient denies using drugs. Patient reports that he was here yesterday looking for detox placement and does not know what happened but his disposition was marked as AMA.Patient denies nausea, chest pain, abdominal pain, diarrhea, hematuria, hematochezia, measured fever, chills, and lower extremity pain or swelling." "Assessment/Plan:    Seizure activity likely due to alcohol withdrawal versus PRES Elevated liver enzymes due to alcohol abuse Metabolic encephalopathy with increased  anion gap due to elevated lactic acid, alcoholic ketosis Hypophosphatemia due to alcohol abuse Substance abuse Hx of GI bleed Small subarachnoid bleed. ER spoke to neurosurg. Monitor.  Anterior dislocation of right shoulder. Reduced in ER Blood pressure control Received Keppra ER Will watch him without Keppra Will consult urologist tomorrow CIWA Librium and Ativan  Drug screen +Fentanyl Neuro checks"   Progress note from Dr. 1/11/22 at 1129: "Neurology Progress Note     Subjective: Patient is a 33 y.o. male admitted to the hospital with altered mental status and a seizure at home.  Patient also admitted to polysubstance abuse recently.  MRI of the brain showed findings concerning for posterior reversible encephalopathy syndrome.  Patient has not had any further seizures since hospitalization.  EEG did not reveal any epileptiform discharges.     REVIEW OF SYSTEMS: 1) constitutional: negative  2) cardiovascular: negative  3) respiratory: negative  4) musculoskeletal: negative  5) endocrine: negative  6)skin: negative  7) HEENT: negative  8) genitourinary: negative 9) psychiatric: negative  10) neurologic: positive for generalized fatigue and weakness" "Assessment: and Plan:   1) posterior reversible encephalopathy syndrome most likely from underlying toxic etiology, patient drug screen was positive for fentanyl, also admits to recent polysubstance abuse and alcohol abuse, EEG did not reveal any epileptiform discharges and hence will not recommend any antiepileptic medications Recommendations: -I had a detailed discussion about patient's polysubstance abuse and alcohol abuse and counseled him to refrain from both -counseled about medication compliance and follow up, do not recommend any antiepileptic medications currently -treatment of alcohol withdrawal and detox as per primary team -patient can follow up in Neurology Clinic as needed -please call Neurology for any questions"