Altered Mental Status in an Octogenarian: How Frequently Should Serotonin Syndrome Be Considered?

Serotonin toxicity, an adverse consequence of elevated serotonin levels in the brain, poses a considerable threat to life. Antidepressants, frequently prescribed for various conditions in older adults, such as depression, anxiety, and sleep disturbances, significantly contribute to this risk. The elderly are particularly vulnerable due to multiple comorbidities, cognitive decline, medication interactions, polypharmacy, and chronic kidney disease. This case underscores the critical importance of considering serotonin syndrome as a potential diagnosis in patients using serotonin and norepinephrine reuptake inhibitors, especially within vulnerable populations. Here, we present the case of an 89-year-old female who presented with altered mental status and a hypertensive emergency. Following a thorough examination and exclusion of alternative causes of acute encephalopathy, serotonin syndrome induced by the use of venlafaxine and oxycodone was diagnosed.

Severe Gastroenteritis From Giardia lamblia and Salmonella Saintpaul Co-Infection Causing Acute Renal Failure.

Giardiasis, a feco-oral route parasitic intestinal infection, and Salmonellosis, a foodborne enteric and extraintestinal bacterial infection, remain major public health issues in countries that lack adequate sanitation, safe water supply, and proper food handling. Here we report a case of Giardia lamblia and invasive non-typhoidal Salmonella disease co-infection in a patient with a history of recent travel to Mexico.

Surveillance of Gallbladder Polyps: A Literature Review.

Little has been documented in existing literature regarding incidentally found gallbladder (GB) polyps. These clinically asymptomatic lesions are mostly benign, with only 5% progressing to malignancy. GB cancer, although rare, presents as an end-stage incurable disease. According to the current guidelines, cholecystectomy is recommended for polyps >10 mm in size for a better outcome. Thus, it is essential to know the clinical picture, surveillance, and treatment of these polyps earlier in the course of the disease to avoid the advancement of polyps to malignancy. This paper discusses the signs and symptoms, surveillance, treatment, and prognosis of GB polyps.

Silent Sigmoid Colon Diverticular Perforation: A Case Report.

Colonic perforation is associated with high mortality rates, and it requires prompt diagnosis and intervention to ensure favorable patient outcomes. The condition usually presents with typical peritoneal signs and symptoms, but atypical presentations can be a diagnostic challenge. In this report, we present a case of sigmoid diverticulosis perforation in an elderly patient who had no symptoms after the perforation developed. This case highlights the importance of detailed history, physical examination, and a low threshold of suspicion in patients with risk factors for atypical presentations.