A 46-Year-Old Hospitalized Man Is Evaluated for Confusion

A 46-year-old hospitalized man is evaluated for confusion.  He was admitted 3 days ago after a motor vehicle collision in which he was a passenger.  He sustained fractures of the right tibia and fibula, which were surgically reduced and fixed.  The patient had a small subdural hematoma without midline shift, which was managed nonoperatively.  He has been receiving intravenous morphine for pain control.  This morning, the patient was agitated and disruptive and was talking to persons who were not there.  He has no significant medical history and takes no regular medications.  Temperature is 37.5 C (99.5 F) , blood pressure is 170/100 mm Hg, pulse is 120/min and regular, and respirations are 22/min.  Pulse oximetry shows 96% on room air.  The patient appears diaphoretic and tremulous and is trying to pull out the intravenous lines.  He is not cooperative for funduscopic examination, but pupils are equal and reactive bilaterally.  Breath sounds are normal and no heart murmurs are heard.  The abdomen is soft and nontender.  The surgical incision shows no surrounding erythema.  The patient moves all extremities without limitations.  Which of the following is the most likely cause of this patient's acute confusion?

A) Delirium tremens
B) Elevated intracranial pressure
C) Fat embolism syndrome
D) Malignant hyperthermia
E) Neuroleptic malignant syndrome
F) Opiate intoxication
G) Pulmonary embolism

Correct Answer:

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