A 25 year old female spelunker presents to your clinic. Since you are thirsty, you pull out a bottle of water, and as you do so, she gasps in panic and looks terrified.
Challenge: What's the diagnosis?
It'd be impressive if you could figure it out from just that, but you take a more thorough history. The patient says that she's really thirsty but can't look at water. She's been having trouble swallowing. She's salivating and febrile. She thinks she had the flu last week: muscle weakness, loss of appetite, sore throat, headache, low grade fever, and nausea. You request a psychiatric consult which suggests recent hypomanic episodes.
It's a pretty cool case, but she'll die if you can't figure this out. You admit her to your service.
1. What's up with spelunking?