7th June 2023

An 85-year-old woman is admitted to the acute medical unit with a urinary tract infection

An 85-year-old woman is admitted to the acute medical unit with a urinary tract infection. She was under investigation by the memory clinic for progressive cognitive impairment, hallucinations, and a tremor. She has persistent nausea and vomiting and is started on regular metoclopramide. After three or four days in hospital, she deteriorates and develops a fever, tachycardia, and new delirium. Her blood shows metabolic acidosis with acute kidney injury and a raised creatine kinase.

Of the following options, which is the correct cause for her deterioration?