A 50-year-old female factory worker was referred to the admitting medical
team by the duty police surgeon. The police had been called to her
house during the night by her husband after she had begun acting in a violent
and agitated manner. She was convinced that there were intruders in
the house and had chased her husband round the house with a knife thinking
that he was one of them. On arrival on the medical admissions unit in the
afternoon of the following day, she was behaving normally and was able to
answer questions although she had poor recollection of the events overnight.
She remained convinced that there had been intruders in her house, but
was aware that she might have been hallucinating at times. She described
being unwell for the preceding 4 days with vomiting and abdominal pain that
was central and constant but this had largely resolved. She had also been
constipated.
She had had one previous admission 6 months previously for vomiting
and abdominal pain. Endoscopic examination was normal. There was a
past history of hypertension, gout, osteoarthritis of the left hip, and
increased alcohol intake. There was no known family history. She was
taking atenolol, tramadol, lansoprazole, and aspirin, and denied illegal
drug use.
On examination, she was apyrexial, pulse 90/min and BP 100/63 mmHg.
There was no abdominal abnormality, neck stiffness, or photophobia.
MTS was 9/10 with no focal neurological abnormality. There was some
scarring over the knuckles of both hands and the suggestion of early blister
formation.
Investigations showed:
● Hb 12.6g/dL,WCC × 109/L, plt139 × 109/L
● ESR 11mm/h, CRP<8mg/L
● Na 139mmol/L, K 3.3mmol/L, glc 6.4 g/dL, Cr 152μmol/L
● LFTs normal, amylase 75mmol/L
● ABG on air: pH 7.44, pCO2 4.23kPa, pO2 9.64kPa, lactate 3.5 mmol/L,
bicarbonate 23.2mmol/L
● Urinalysis: normal
● Abdominal ultrasound: no abnormality seen.
Over the next 2 days, she remained well with no further episodes of disturbed
behaviour.