The Patient with Delirium and Dementia in the Emergency Department

You are working in the emergency department one night when a young male brings in his agitated brother with a history of schizophrenia, stating, “His schizophrenia is acting up again.” You watch as the patient is brought back to a room, intermittently thrashing about the stretcher. You are able to calm him long enough to obtain vital signs and check his glucose, which is shockingly low. The nurse swiftly obtains IV access and gives him dextrose-containing fluids. To the brother’s astonishment, the patient’s status immediately reverts back to normal. You realize this change in mental status was secondary to delirium caused by hypoglycemia. The patient reports he forgot to eat after taking insulin, causing this predicament. As further diagnostic studies are underway, you learn of an impending case of Alzheimer’s dementia found wandering outside the nursing home …