Image IQ: 78-Year-Old Presenting with Confusion, Recent Vomiting

A daughter rushed her 78-year-old father to the ED after finding him in a state of confusion. The father had obviously vomited recently, but not cleaned up, which was atypical behavior. He lived alone and his daughter visited every other day, so she wasn’t sure exactly how long her father had been sick. She reported that as they drove to the hospital, her father complained that it was too bright outside and asked why the sky was yellow, but she wasn’t sure if he was confused or actually seeing yellow. He seemed very agitated compared to his typically calm demeanor. At the ED, his doctor noted tachycardia and ordered an ECG. Blood results showed hyperkalemia. The daughter reported that he did take a few daily medications, but she was in such a hurry she had forgotten to bring his pill bottles.

1. Concussion
2. Diabetic ketoacidosis
3. Beta-blocker toxicity
4. Digitalis toxicity

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