Acute altered sensorium in a young industrial worker with suspected polysubstance intoxication and possible occupational inhalational exposure: A case report

Abstract

Acute altered sensorium in an adolescent or young adult poses a broad differential diagnosis that includes recreational 
drug intoxication, substance abuse, hypoglycemia, occupational inhalational exposure, and less common causes 
such as viral encephalitis and non-convulsive seizures. We report the case of a 19-year-old male industrial worker 
who presented to the emergency department with disorientation, incoherent speech and relative bradycardia, with 
no focal neurological deficit. Initial work-up revealed hyperglycemia, transient hyponatremia and sinus bradycardia 
with right axis deviation on electrocardiography. Based on a broad initial differential, the clinical picture evolved to 
favor a working diagnosis of suspected cannabis intoxication, layered on a probable alcohol-use pattern and possible 
occupational inhalational exposure, pending confirmatory toxicology. The patient recovered fully with supportive care, 
empirical high-dose parenteral thiamine and psychiatric liaison. The case illustrates the diagnostic challenge posed by 
suspected polysubstance and occupational exposure in young workers and the value of a structured, hedge-appropriate 
diagnostic approach in the absence of immediate toxicological confirmation.