19th March 2024

You are asked to review a 19 year old patient in the emergency department whom has arrived confused and restless

You are asked to review a 19 year old patient in the emergency department whom has arrived confused and restless. It is not possible to take a full history from the patient in his current state, so you contact his next of kin (NOK). They are able to tell you that he has been suffering from low mood recently following a break-up. He has been drinking large volumes of alcohol every day. His GP has recently prescribed him a tablet to help with his mood. Other than this, there is no significant past medical history that his NOK is aware of. She assures you that he is usually very active and takes lots of vitamins and supplements.

On examination, the heart rate is 115 and blood pressure is 160/95 mmHg. There is twitching of the upper limbs and hyperreflexia.

Which of the following is the most likely cause of his presentation?

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