Coma and Impaired Consciousness (Assessment & Diagnosis) — 58yo Man | Nephrology | MCCQE1 Q#11471
MCCQE1 Question #11471
Dimension of Care
Acute Care
Activity
Assessment & Diagnosis
Objective
Coma and Impaired Consciousness
Section
Medicine / Family Medicine
Subject
Nephrology
Last updated: February 2026
A 58-year-old man with end-stage renal disease on intermittent hemodialysis is brought to the emergency department for progressive confusion and drowsiness over 4 days. He missed his last three dialysis sessions because of transportation problems. Over the past 24 hours, he became increasingly difficult to arouse and is now unresponsive. On examination, he is comatose with a Glasgow Coma Scale score of 6, has a strong urine-like odour on his breath, and demonstrates asterixis when briefly stimulated. There is no fever, meningismus, or focal neurological deficit. What is the diagnosis?
Full answer analysis and choices are available inside the practice session.
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