Question

CAN YOU PLEASE ANSWER AS SOON AS POSSIBLE THANK YOU

Your goal is to generate a diagnosis. if you cannot narrow the choices to just one, then give a shortlist of the most likely, in order of likelihood (a 'differential diagnosis'). Explain why you have chosen the diagnosis (what about the vignette makes you think this is the explanation?). What would you do to confirm the diagnosis? Can you suggest initial treatment? This can usually be done in a single page

A 71-year-old man was brought to the emergency department by his family because of 2 days of progressive confusion. He had no medical history. His family reported that he might be a little forgetful and he took a wrong turn and got lost while driving home from a dentist’s appointment 1 week after he had a tooth extraction. He took no routine medications, although the dentist had prescribed Oxycontin for pain.

Vital signs were remarkable for a temperature of 38.1C (100.5F). The general physical examination showed mild suprapubic tenderness. There was no periodontal abscess. Neurologic exam was notable for disorientation, confusion, and visual hallucinations. MMSE was attempted but he could not complete it. A urinalysis was positive for nitrites and numerous white blood cells, and the patient was hospitalized for urinary tract infection and delirium. The evening of admission, he became agitated and tried to leave the hospital, saying that the nurses were holding him hostage. He was restrained and given a dose of IM haloperidol after which he fell asleep. The next morning when his family arrived they found him in restraints and barely arousable.

Answer 1

These are all side effects of opoids .

Oxycontin is a opiod . It is containdicated in elderly . Because it causes urinary retention and respiratory depression . Hence it is contraindicated in elderly .

Sedation , mental clouding , lethargic are other side effects

Due to urinary retention urinary tract infection has occured , which cause fever, .there may may elevation in urea level which causes delirium.

Treatment is respiratory support and maintenance of BP.. withdrawal of drug . Specific antidote Naloxone 0.4 mg is given repeated every 4 hours.