Question

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Please help read case study below and answer these question

Question 1

What is the most likely explanation for his altered mental status?

	A.	Alcoholic hallucinosis
	B.	Pneumonia and sepsis
	C.	Heavy metal poisoning
	D.	Frontal lobe stroke

For this question please give me rationalities of your choice

Question 2

Give me explaination about pathophysiology of how mercury poisoning effect Respiratory Failure

Respiratory Failure

Patho

• Case study

A 60-Year-Old Man with Acute Respiratory Failure and Mental Status Changes

History

A 60-year-old man presented to the emergency department complaining of persistent right-sided chest pain and cough. The chest pain was pleuritic in nature and had been present for the last month. The associated cough was productive of yellow sputum without hemoptysis. He had unintentionally lost approximately 30 pounds over the last 6 months and had nightly sweats. He had denied fevers, chills, myalgias or vomiting. He also denied sick contacts or a recent travel history. He recalled childhood exposures to persons afflicted with tuberculosis.

The patient smoked one pack of cigarettes daily for the past 50 years and denied recreational drug use. He reported ingesting twelve beers daily and had delirium tremens, remote right-sided rib fractures, and a wrist fracture as a result of alcohol consumption. He had worked in the steel mills but had discontinued a few years previously. He collected coins and cleaned them with mercury.

The patient’s past medical history was remarkable for chronic “shakes” of the upper extremities for which he had not sought medical attention. Other than daily multivitamin tablets, he took no regular medications.

Hospital course

He was initially admitted to the general medical floor for treatment of community-acquired pneumonia (see Figure 1) and for the prevention of delirium tremens. He was initiated on ceftriaxone, azithromycin, thiamine and folic acid. Diazepam was initiated and titrated using the Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWAS-Ar), a measure of withdrawal severity (1). By hospital day 5, his respiratory status continued to worsen, requiring transfer to the intensive care unit (ICU) for hypoxemic respiratory failure. His neurologic status had also significantly deteriorated with worsening confusion, memory loss, drowsiness, visual hallucinations (patient started seeing worms) and worsening upper extremity tremors without generalized tremulousness despite receiving increased doses of benzodiazepines.

Physical Exam

On arrival at the medical ICU, the patient appeared cachectic and dyspneic. He was unable to complete sentences. His blood pressure was 125/71 mm Hg, heart rate of 122/min, temperature 100 °F, respiratory rate 33/min, and oxygen saturation 77% on room air and 92% on 40% venti-mask. At the time of presentation to the hospital, he had an oxygen saturation of 92% on room air. The heart exam revealed tachycardia but regular rhythm, a normal S1 and S2 and no murmurs, gallops or rubs. On auscultation of the lung fields, breath sounds were diminished on the right side in the upper zone without the presence of adventitious sounds. The abdomen was benign without organomegaly. The patient’s extremities were normal with absence of clubbing or edema. He was oriented only to person, and had an inability to pay attention or remember immediate events. He was moving all four extremities with slightly brisk deep tendon reflexes. Neck was supple and the pupils were brisk in reacting to light.

Answer 1

Answer: Heavy metal poisoning.

( The heavy metal poisoning causes alterations in thinking ability. It causes neurological defects as accumulation of heavy metal causes deterioration. Mercury inhalation gets in to blood stream.)

Answer: The mercury poisoning directly affects the respiratory system. It elevates the respiratory disease as it causes toxicity in the lungs. This causes respiratory failure as well as it absorbs in the blood streat which reduced the oxygen content in the body. Hence it causes long term respiratory failure.