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An 85-year-old woman, a case of diabetes mellitus, hypothyroidism, dementia and stage 4 chronic kidney disease, was admitted with an Escherichia coli urinary tract infection with a rise in serum creatinine from 1.8 to 4.6 mg/dL. She was treated with intravenous antibiotics (cefoperazone sulbactam). Tablet memantine 10 mg once daily was started for suspected Alzheimer’s dementia. Other medications included thyroxine, linagliptin and erythropoietin. After 5 days, the patient developed somnolence and decreased responsiveness, which rapidly worsened over the next 2 days when the patient became unresponsive to verbal and painful stimuli. There was no history of abnormal body movements, fever or decreased urine output. Examination revealed no focal neurological deficit and bilateral plantars were flexor. Complete blood count, arterial blood gas, serum electrolytes, liver function tests and Serum thyroid stimulating hormone …
Contributors The idea for writing this manuscript was conceived by PP and SB. PP wrote the original draft of the article. DK and SB made major revisions to the draft and approved the final version. Final submission was done by PP.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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