A 65-Year-Old Man Is Being Evaluated in the Hospital Due

question 4

Multiple Choice

A 65-year-old man is being evaluated in the hospital due to altered mental status and fever.  He was admitted 10 days ago for acute pancreatitis secondary to alcohol use.  On admission, the patient was afebrile, and CT scan revealed pancreatic edema and necrosis.  He has been receiving intravenous fluids and intravenous opioid pain control since then.  Today, the patient appears confused and requests more pain medication.  Temperature is 38.9 C (102 F) , blood pressure is 90/64 mm Hg, pulse is 120/min, and respirations are 22/min.  The pupils are 2 mm and symmetric, and the neck is supple.  The lungs are clear to auscultation, and heart sounds are normal.  Bowel sounds are decreased, but the abdomen is nondistended; there is tenderness to palpation in the epigastrium.  The flanks are tympanic to percussion, without any fluid wave.  Neurologic examination shows no focal findings.  Which of the following is the best next step in management?

• A)Administration of naloxone
• B)CT scan of the abdomen
• C)CT scan of the head
• D)Intravenous lorazepam
• E)Lumbar puncture
• F)Serum ammonia level