A Visit to the ED
Mr. Hake misses his next scheduled clinic follow-up appointment. Four months after his last clinic visit, Mr. Hake is transported to the ED after his daughter visited him at his home and found him confused and combative. Upon arrival to the ED, Mr. Hake is somnolent but able to be aroused. He is oriented to self and place only. His vitals are only remarkable for a BP of 172/96. His neurologic exam is unremarkable but due to his somnolence, his gait is not observed and cerebellar testing is not fully done. A non-contrast head CT only reveals some small vessel chronic ischemic changes and mild cortical atrophy. His labs reveal an ethanol level of 182 mg/dL, normal CBC and chemistries. A urine tox screen is negative.