23rd May 2025

A 67-year-old man presents to ED acutely unwell.

A 67-year-old man presents to ED acutely unwell. He appears confused with high  respiratory effort. His heart rate is 50bpm, and ECG shows 1st degree heart block. His temperature is 35.50c, and on examination he has hypotonia and hyporeflexia. There are no other findings on examination. He had a recent cerebrovascular event from which he was improving. Patient had a CXR, sepsis screen, CT head which did not show any acute changes. Blood glucose is normal. He is a non-smoker and teetotal. His past medical includes T2DM, HTN, angina and Hashimoto’s disease, which was diagnosed a year ago. . He takes metformin 500mg TDS, Ramipril 2.5mg OD, Bisoprolol 5mg OD, clopidogrel 75mg OD, and levothyroxine 20mcg OD. What is the most likely provisional diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.