A 28-Year-Old Man With Consecutive Gastrointestinal Symptoms, Kidney Failure, and Progressive Neurologic Deterioration.

A 28-year-old man with an unremarkable medical history, no regular medication regimen, and no recent travel history or animal exposure was admitted to the emergency department with new onset of disorientation, slurred speech, and hearing loss. One day prior, the patient had consulted his general practitioner for fever, recurrent vomiting, and myalgia. According to his family, the patient smoked cigarettes and daily ingested γ-hydroxybutyrate. Because of the patient's limited ability to communicate, recent ingestion of other substances could not be ruled out. The patient was admitted to the ICU because of severe metabolic acidosis, electrolyte imbalances, and acute renal failure of indeterminate origin. Hemodialysis was started right after admission.