The patient is a 40-year-old female that presents to the ED with altered mental status. The family reports the patient was fine in the morning prior to presentation when suddenly she started behaving weirdly and they brought her into the ED. The family did not witness any seizure activity, nausea, vomiting, fever or pain. The patient is known to have a medical history consistent with rheumatoid arthritis, depression, fibromyalgia and bulimia. She has had total replacement of the hip, replacement total knee, as well as bypass gastric surgery. Her medications are consistent with Clonazepam Adderall Soma Celebrex Cymbalta 2 different doses of Epitamax, Nexium, Meclizine and Baclofen. Review of the laboratory work reveals that there is actually