MRCP2-4083

MRCP2-4083

A 59-year-old woman presents with vomiting, confusion, and lethargy. She has not sought medical attention for many years, but has a history of using co-proxamol for arthritis and takes a diuretic for hypertension. On examination, she has hyper-reflexia, nystagmus, and clonus, and her blood pressure is 165/85 mmHg. There is also evidence of vaginal bleeding. Her blood tests show elevated levels of urea, creatinine, and potassium. What is the most likely diagnosis for this patient?