Skip to Main Content




A 71-year-old Caucasian man was brought to the emergency department (ED) for left-sided weakness and confusion. According to his wife, he was found on the floor in his bathroom at home with a paralyzed left arm and leg and slurred speech. This was 6 hours before he came to the ED. The patient has a history of non–insulin-dependent diabetes, hypertension, and hyperlipidemia. On arrival to the ED, he was confused and was noted to have left hemiparesis and left facial droop with aphasia. The vital signs revealed a blood pressure of 119/60 mm Hg, pulse of 119 beats per minute (bpm), respiratory rate of (RR) 33 breaths/min, and arterial oxygen saturation (Sao2) of 85%. He was intubated and ventilated after appropriate sedation and chemical paralysis. A noncontrast computed tomography (CT) scan of the head was performed, which showed a dense right middle cerebral artery sign and no evidence of acute intracranial hemorrhage. The electrocardiogram revealed atrial fibrillation. The radiograph of the chest revealed appropriate endotracheal tube position and a right lower lobe infiltrate.

On his arrival in the neurologic intensive care unit (ICU), his vital signs showed a temperature of 36.4°C (97.5°F), pulse of 132 bpm (sinus), respirations (ventilated) at 14 breaths/min, blood pressure of 113/47 mm Hg, and oxygen saturation of 100%. On physical examination, he appeared acutely ill and cachectic. The carotid pulses were equal, and there were no bruits. A pulmonary examination demonstrated right lower lobe crackles. The heart sounds were normal. The limbs were well perfused, and the abdomen revealed diminished bowel sounds with a soft and nondistended abdomen. A musculoskeletal examination showed moderate diffuse muscle wasting. The neurologic examinations were not informative because of deep sedation. The results of laboratory tests are shown in Table 51-1.

According to his wife, he retired a year ago from his previous occupation as a taxicab driver for 40 years. He had been smoking 1 pack of cigarettes per day on average for 35 years and drank alcohol occasionally. For the last 5 months, his appetite has been decreased and he has been eating small portions at 2 to 3 meals per day. He lost 15 lb (6.8 kg) during the past 5 months and his most recently measured weight was 115 lb (52 kg). His height was 5 feet and 8 inches (172 cm).

Table Graphic Jump Location
Table 51-1.Laboratory Values on Admission

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.