MRCP2-3282

MRCP2-3282

A 65-year-old female is admitted to the acute medical unit after experiencing a prolonged tonic-clonic seizure. She has been diagnosed with status epilepticus and treated with lorazepam and a phenytoin infusion. Two days later, you are consulted to assess her ongoing confusion. The patient has a history of depression and is currently taking fluoxetine.

Upon examination, her cardiorespiratory system appears normal, and her abdomen is soft and non-tender. However, you notice rapid blinking, which the nursing staff confirms has been ongoing for the past 24 hours.

The following are the results of her investigations:

– Hb 135 g/l
– Na+ 137 mmol/l
– Bilirubin 14 µmol/l
– CRP <4 mg/l
– Lactate 1.2 mmol/l
– Albumin 32 g/l
– Platelets 385 * 109/l
– K+ 4.2 mmol/l
– ALP 88 u/l
– WBC 6.6 * 109/l
– Urea 4.4 mmol/l
– ALT 44 u/l
– Neuts 4.2 * 109/l
– Creatinine 75 µmol/l
– γGT 68 u/l
– Lymphs 2.2 * 109/l
– Eosin 0.2 * 109/l

What is the most likely diagnosis?