An elderly man is brought to the emergency department by his daughter for altered mental status and visual hallucinations that seemed to have started the day before and are getting worse. The daughter says he is not really confused, but is rambling on about things that are not there or have not happened. There has been no fever, vomiting, headache, or other complaints. He has a history of diabetes and glaucoma and recently saw his ophthalmologist, who said his pressures were a little high and added a new medication.
Results of physical examination: Temp, 97.8; blood pressure, 131/77 mmHg; pulse, 54 beats/min; respirations 18 breaths/min; pulse ox, normal.
He is alert and oriented x3 and is aware that he has been seeing things. His exam is otherwise essentially normal, with a non-focal neurologic exam.
Lab work is normal except for a glucose of 122 mg/dL.
Figure above is a tracing from and ECG taken in the ED. Please click to enlarge.
1. What one condition could be causing both the altered mental status and the EKG findings?
2. If no other cause is found, how should this patient be managed?