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Patient: a woman aged 77 years
The patient had type II diabetes since her 50s which had been fairly well controlled and also suffered from an old myocardial infarction, but had been able to live alone in her apartment, managing the household on her own. She caught a common cold several days ago, which worsened the next few days, and the patient was febrile, unable to eat or drink. The daughter living in the neighbourhood took her to the hospital, where she was diagnosed with severe pneumonia and dehydration and was hospitalised. In the general medicine ward, however, she developed delirium the night she was admitted.
At night, she was agitated and claimed that she had to go to work and that her husband (deceased) was in the room. She was often somnolent during the day, although she did have some relatively clear moments. She was able to communicate at those moments, but her attention was short and her speech was often incoherent.
Course of illness
Dehydration and pneumonia responded well to medical treatments but chronic heart failure persisted. As a consultant …
Competing interests TAF has received lecture fees from Eli Lilly, Janssen, Meiji, MSD, Otsuka, Pfizer and Tanabe-Mitsubishi, and consultancy fees from Sekisui Chemicals. He has received royalties from Igaku-Shoin and Nihon Bunka Kagaku-sha publishers. He has received research support from Mochida and Tanabe-Mitsubishi.
Provenance and peer review Commissioned; externally peer reviewed.
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