A 65-Year-Old Man with Chronic Obstructive Pulmonary Disease, Atrial Fibrillation

A 65-year-old man with chronic obstructive pulmonary disease, atrial fibrillation, hypertension, and type II diabetes mellitus comes to the emergency department due to shortness of breath for 3 days.  The patient's condition began with a runny nose, itchy eyes, and sore throat.  His symptoms progressed to productive cough, wheezing, and dyspnea.  On examination, blood pressure is 150/90 mm Hg and pulse is 110/min and irregular.  Oxygen saturation is 91% on room air.  Examination shows a mildly overweight man in moderate respiratory distress.  Lung sounds are decreased throughout, with prolonged expiration and bilateral wheezes.  The patient is started on inhaled bronchodilators, systemic corticosteroids, high-flow facial mask oxygen, and intravenous lorazepam for agitation.  Thirty minutes later, he is lethargic and confused.  Shortly thereafter, he experiences a generalized tonic-clonic seizure.  Which of the following most likely contributed to this patient's neurologic symptoms?

A) Carbon dioxide retention
B) Cerebral vasoconstriction
C) Hypocalcemia
D) Metabolic acidosis
E) New-onset thromboembolic stroke
F) Subarachnoid hemorrhage

Correct Answer:

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