03-19-2008, 12:21 PM
A 72-year-old woman with metastatic rectal cancer is admitted to the hospital because of weakness and altered mental status. She has bilateral ureteral stents due to prior obstruction from the cancer. She has been using a fentanyl patch for several weeks. Physical examination on admission is notable for lethargy and 3-mm reactive pupils but no focal neurologic signs. She is afebrile and has a blood pressure of 120/82 mm Hg. Laboratory studies show serum urea nitrogen (BUN) concentration of 60 mg/dL and a serum creatinine concentration of 6.2 mg/dL. Serum bilirubin concentration is normal. One week ago serum BUN concentration was 30 mg/dL and serum creatinine concentration was 3.0 mg/dL. Which of the following is the most likely explanation for her altered mental status?
A
) Fentanyl intoxication
B
) Hepatic encephalopathy
C
) Hypercalcemia
D
) Uremia
E
) Urosepsis
A
) Fentanyl intoxication
B
) Hepatic encephalopathy
C
) Hypercalcemia
D
) Uremia
E
) Urosepsis