]> 2026-07-31T07:28:19+00:00 WBR0220 0 en Discontinue rosiglitazone Discontinue hydrochlorthiazide Perform a lumbar puncture. Order thyroid function tests. '''Correct''' : Apathetic thyrotoxicosis is an atypical though not rare manifestation of hyperthyroidism that requires high level of suspicion and could be ruled out through thyroid function tests. Discontinue sertaline. Emergency Room A 76 year old female is admitted to the hospital because of altered mental status. She has a history of diabetes, hypertension, osteoporosis and mild depression. At home, she was on metoprolol, rosiglitazone, hydrochlorthiazide and sertaline. She also takes alendronate on a weekly basis. She has been on these medications for a number of years. Before admission, she was living independently in her apartment and was able to perform nearly all day-to-day activities. It was her daughter who found her in her apartment, very confused in her bed. On examniation, you see a drowsy, frail, elderly women in no acute distress. Her temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 102/min and respiartions are 16/min. Her oxygen saturation is 97% on room air. The neck is supple without any jugular venous distension or thyroid enlargement. The oropharynx is dry. Pupillary reflexes are intact. There is no obvious pallor or icterus. Lungs are clear to auscultation. Cardiovascular and gastrointestinal systems are unremarkable. On neurological examination, the patient is not very cooperative. She knows her name but disoriented to time and place. She can move all her extremities. Touch sensation are intact and deep tendon reflexes are symmetrical. On lab investigations, total and differential white count is normal. Her Hemoglobin and hematocrit are 12.3 g/dl and 36.5 respectively. Serum biochemistry shows Na:135 mEq/L, K : 3.6 mEq/L, Cl: 104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose: 72 mg/dl and Ca: 10mg/dl. A CT scan of the head performed in the emergency department shows generalized cerebral atrophy. What is the most appropriate next step in the management of this patient? D Endocrine Neurology 2020-10-27T23:48:27Z 2459150.4919792 WBR0220