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In Memoriam
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July 2018 Critical Care Case of the Month

Stephanie Fountain, MD

Banner University Medical Center Phoenix

Phoenix, AZ USA


Critical Care Case of the Month CME Information

Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours 

Lead Author(s): Stephanie Fountain, MD.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives: As a result of completing this activity, participants will be better able to:

  1. Interpret and identify clinical practices supported by the highest quality available evidence.
  2. Establish the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Translate the most current clinical information into the delivery of high quality care for patients.
  4. Integrate new treatment options for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine

Current Approval Period: January 1, 2017-December 31, 2018

Financial Support Received: None


History of Present Illness

A 45-year-old man was brought to the Emergency Room by his mother complaining of weakness, dizziness, and trouble swallowing. He was also incontinent of stool and looked “sunburned”.

Past Medical History

He has a past medical history of:

  • Schizophrenia
  • Depression
  • Polysubstance abuse
  • Crohn’s disease
  • Type 2 diabetes
  • Hyperlipidemia


  • Prazosin
  • Venlafaxine
  • Risperidone
  • Buspirone
  • Oxcarbazepine
  • Gabapentin
  • Hydroxyzine
  • Lithium
  • KCL
  • Metformin
  • Atorvastatin
  • Adalimumab
  • Mesalamine
  • Prednisone
  • Ferrous sulfate

Physical Examination

  • Vitals: 80 kg / 97.3 degrees / 101 bpm / 100% 28RR  / BP 111/72 
  • The patient was toxic appearing and flushed.
  • Oriented to self only, very lethargic
  • Dry mucous membranes
  • Lungs clear to auscultation and percussion
  • Heart tachycardic but no murmurs
  • Abdomen without organomegaly, masses or tenderness
  • Extremities without edema

Which of the following should be done at this time? (Click on the correct answer to be directed to the second of six pages)

  1. Electrolytes
  2. Lumbar puncture
  3. Urine drug screen
  4. 1 and 3
  5. All of the above

Cite as: Fountain S. July 2018 critical care case of the month. Southwest J Pulm Crit Care. 2018;17(1):7-14. doi: PDF

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