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A 80-year-old male with a past medical history of hypertension, type 2 diabetes, dementia and chronic renal insufficiency is transferred from a long-term care facility with nausea and vomiting. The staff at the facility endorse she over the past few days she has become increasingly confused. On Exam, her vital signs are blood pressure 106/45, pulse 75, respirations 24, temperature 38.9°C (102°F), and oxygen saturation 95% on room air. On initial appearance, patient is somnolent, confused.