Totally Confused

A 34 year old man presents with fever and confusion for 4 days. No other symptoms were seen.

He was diagnosed with schizophrenia a month ago, and started on olanzapine soon afterwards. His medical and surgical histories are otherwise unremarkable.

A complete blood count is significant for a WBC of 12,000/mm3 (normal: < 11,000), with 65% neutrophils and 34% lymphocytes.

A random capillary glucose and liver profile are within normal parameters.

Select Relevant Investigations
Renal Functions + Electrolytes

Performed

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)
Blood Urea: 35 mg/dL (10-50)
S. Creatinine: 0.7 mg/dL (0.5-1.5)
Creatine Phosphokinase (CPK)

Performed

Creatine Phosphokinase (CPK): 23,000 U/L (22-198)
Toxicology Screen

Performed

The Toxicology Screen is negative.
CT Brain + Lumbar Puncture

Performed

The CT scan of the brain and CSF analysis are completely normal.

Select Relevant Management
Antibiotics
Antipyretics
Stop Olanzapine
ICU Care