Case Report: Altered College Student

History: A 20-year-old female is brought to the emergency department by EMS for altered mental status. Her roommate found her lethargic in bed with the lights and music on and an empty bottle of vodka near her bedside. Medics state that the roommate told them she has a history of depression and just broke up with her girlfriend. She hadn’t seemed physically ill in the past few days but had been complaining of a headache.

Exam: Vital signs are normal except for borderline tachycardia. On exam, she is lethargic with slurred speech to painful stimuli. Pupils are equal and react although a bit sluggishly. She has no obvious focal deficits but is unable to cooperate with the neurologic exam.

An EKG is performed:

Computer Read: Rate 94, PR 254, QTc 395. Normal sinus rhythm with first-degree AV block. Nonspecific ST and T wave abnormality