Forgotten but Not Gone

• Published in: The New England journal of medicine Vol. 350; no. 23; pp. 2399 - 2404
• Main Authors: Jha, Ashish K, Shojania, Kaveh G, Saint, Sanjay
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 03.06.2004
• Subjects: Abdomen; Biological and medical sciences; General aspects; Heart attacks; Medical sciences; Medical treatment; Pneumonia; Streptococcus infections; Medicine
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMcps032575

A 74-year-old man was brought to the emergency department after being found confused and incapacitated at home. The patient lived in a residential hotel and had previously been healthy and socially active. Having not seen him for three days, his friends entered his room and found him on the floor, covered in stool. The patient was conversant but confused. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 74-year-old man was brought to the emergency department after being found confused and incapacitated at home. The patient lived in a residential hotel and had previously been healthy and socially active. Having not seen him for three days, his friends entered his room and found him on the floor, covered in stool. The patient was conversant but confused, recalling only a recent fall and his inability to get up. Response Causes of acute alteration in mental status fall primarily into four categories: infectious, neurologic, drug-related, and metabolic. In elderly patients, infections are the most common cause, although the . . .