Totally Confused

Behavioral Health

Step 1: View Clinicals

A 34-year-old man presents with fever and confusion for four days. No other symptoms are present. He was diagnosed with schizophrenia a month ago and started on olanzapine. He is not on any other medications. His medical, surgical, and psychiatric histories are unremarkable otherwise.

A full blood count is significant for a leukocyte count of 12,000/mm3 (normal: < 11,000), with 65% neutrophils and 34% lymphocytes. A random capillary glucose and liver profile are within normal parameters.

Step 2: Order Relevant Investigations

1. Renal functions + serum electrolytes


Blood urea: 35 mg/dL (10-50)

Serum creatinine: 0.7 mg/dL (0.5-1.5)

Na+: 142 mEq/L (135-145)

K+: 5.5 mEq/L (3.5-5.5)

Cl-: 101 mEq/L (97-105)

Total Ca++: 8.8 mg/dL (8.5-10.9)

2. Creatine phosphokinase (CPK)


CPK: 23,000 U/L (22-198)

3. Toxicology screen


The toxicology screen is negative.

4. CT brain + lumbar puncture


CT imaging of the brain shows no abnormalities.

Cerebrospinal fluid (CSF) analysis is completely normal.

Step 3: Select Appropriate Management

1. Antibiotics


2. Antipyretics


3. Omit olanzapine


4. ICU care