Paramedics were called to a campus party after a 911 call was placed with a report that a 19-year-old male suddenly “passed out.” The paramedics who brought him to the emergency department (ED) by ambulance were told that he is a college student at a nearby university. The patient is not accompanied by anyone. When first-responders arrived, no one at the party was able to give a consistent history of what had happened.
A few students at the party said he suddenly passed out but no one admitted to being with him when he lost consciousness. Further, nobody was able to recall exactly what time he started to become unwell or to display any unusual symptoms before he was found to be unconscious. It is unclear who found him and where exactly he was when he passed out, but the students concurred that he had attended the party. Witnesses denied that the young man was drinking or using drugs or that there was any alcohol or illegal substances at the event. Most of the students were in the process of leaving at the time the ambulance arrived.
The patient's parents were called when he arrived at the hospital. On their three-hour trip way to the ED, the parents provided his medical history, stating that there is no significant medical illness in the family. They also reported that he has no allergies and he does not take any medications except for topical over-the-counter acne cream.
Vital Signs. Pulse is 135, his blood pressure is 90/45, and respiratory rate is 32 breaths per minute. The patient is conscious, but he does not seem to be aware of his surroundings. He is too lethargic to answer questions or follow commands. He opens his eyes briefly in response to sounds. He does not appear to have any involuntary movements and he is not combative.
Skin appears normal with no rashes, wounds, bruises, or discoloration. The patient has had involuntarily loss of bladder control twice after arriving to the ED. Heart rate is regular. Pulses are weak throughout bilateral upper and lower extremities and he does not have carotid bruits. Breathing is shallow and rapid, with clear breath sounds. The abdomen is soft and non-distended with no tenderness.
Neurological examination. The face is symmetric with pupils slightly dilated, equal, round, and reactive to light. Extra ocular movements appear intact without nystagmus. Reflexes are brisk on both the upper and lower extremities without asymmetry and bilateral downgoing response of the toes. Muscle tone is normal in the left upper and lower extremities. In the right upper and lower extremities, muscle tone is diminished and the right leg is flaccid. There is no response to sensory stimuli of his extremities.
Laboratory tests. Blood alcohol level was 0.281%. CBC and electrolyte tests were unremarkable with the exception of serum Na level that was found to be 132 mEq/L (normal range is 135 and 145 milliequivalents per liter [mEq/L]).
Computed tomography. Brain CT scan was normal.
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