Confusion and ataxia in a patient with bipolar

She’s had nausea, vomiting and diarrhoea for the past few days

Marion, a 65-year-old woman, is brought to her GP by her sister, Rhonda.

Senior woman bed sick headache

When Rhonda went to Marion’s home that morning to check on her after not hearing from her for a few days, she found Marion in bed, apparently confused.

She appeared off-balance and required Rhonda’s help to mobilise.

Marion lives alone. She has a history of bipolar affective disorder, treated with lithium, and recently diagnosed hypertension, treated with perindopril.

She has not had a major exacerbation of