The Case | Unexplained stupor with a high osmolal and high anion gap metabolic acidosis

A 51-year-old male with a psychiatric history was admitted to the hospital for evaluation of altered mental status. He had been suffering from an intense itching involving his head and torso for the past 2 years. A thorough evaluation by a dermatologist was negative for any organic skin pathology. Several medications, including cetirizine, hydroxyzine, risperidone, gabapentin, did not alleviate his itching. The patient started applying hand sanitizer diffusely to his skin several times a day. In a desperate attempt to achieve relief, he began scrubbing the sanitizer with a hard brush to his skin, which led to peeling of the epidermis on his back.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research