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A Woman in Her 60s With Fever and Altered Mental Status in a Psychiatric Hospital

Benjamin C. Kalivas, MD; Andrew J. Goodwin, MD
Author and Funding Information

aDivision of General Internal Medicine, Medical University of South Carolina, Charleston, SC

bDivision of Pulmonary, Critical Care, Sleep and Allergy Medicine, Medical University of South Carolina, Charleston, SC

CORRESPONDENCE TO: Benjamin C. Kalivas, MD, Division of General Internal Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Ste 807-CSB, MSC 623, Charleston, SC 29425


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):e171-e174. doi:10.1016/j.chest.2016.06.022
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A woman in her 60s with a history of hepatitis C with cirrhosis and major depressive disorder with psychotic features was admitted to the inpatient psychiatric unit for suicidal ideation. She was initially treated with a combination of sertraline and paliperidone. The paliperidone was subsequently changed to risperidone and ultimately to olanzapine. She developed worsening mental status and was then treated for catatonia with benzodiazepines. Over 2 days, her mental status continued to worsen and she developed fever and tachycardia. She was transferred to the ICU and endotracheally intubated for inability to protect her airway. She was started on lactulose via orogastric tube but showed no improvement in her mental status after 2 days despite having two or three bowel movements per day.


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