b'PACEP SCIENTIFIC ASSEMBLY 2025 CPC HIGHLIGHTWhat is the Diagnosis?A special thank you to Alexandra Amaducci, DO for organizing this years CPC competition during the PACEP25 Scientific Assembly and to Julian Fohrman, MD from Wellspan for submitting the case and being the resident presenter. An additional thank you to Brian Kelly, DO from St. Lukes Health Network for being the attending discussant.Dazed and ConfusedCPC CASE14 year old female presenting with altered mental status which began after waking in the STUDY morning. The patient recently returned from traveling to Florida 7 days ago where she was hospitalized for dehydration and confusion. During first hospitalization, the patient THE CASE woke up with slurred words and said I cant speak. The previous day, she had been in the ocean and had a large amount of ocean water go up her nose.She had a white tongue, very dry mouth and headache. She could not swallow a glass of water.She had no fevers.She became very confused, agitated and combative. The patient had an EEG, CT Head and UDS which were all normal.All of her symptoms resolved within 24 hours.She returned to baseline. Physicians suspected she ingested a synthetic drug causing the symptoms, although patient denied. She was diagnosed with suspected metabolic encephalopathy from ingestion.Today she woke up with the following symptoms: Altered mental status, tachypnea, low grade fever, headache. No clonus or hyperreflexia. No focal neurologic deficits. No known ingestions. No neck pain/stiffness, SOB, cough, congestion, urinary symptoms, N/V/D/C, melena or hematocheziaPast Medical History: headaches time/date, and location.Past Surgical History: none Head: normocephalic, atraumaticSocial History: non-contributory, denies drug orCardiovascular: S1S2, no murmursalcohol use. Lives at home with parents. Abdomen: soft, nontender, nondistendedNKDA Lungs: clear to auscultation bilaterallyMedications: none Rash: noneVital Signs: HR 97 bpm, RR 15 breaths perNeuro: No clonus or hyperreflexia,minute, SpO2 100% on RA, BP 123/61 mmHg, Temp 37.3 C No focal deficits, cranial nerves intactMotor: 5 of 5 strength in the proximal and Physical Exam:distal upper and lower extremities, symmetric bilaterally. Normal tone and bulkGeneral: Encephalopathic: Awake, alert, confusedSensory: Intact light touch and temperature to situation, time, place.Non-somnolent. sensation in all extremitiesResponding to questions but confused on name, 18 PACEP News'