A 35 year old woman with rheumatoid arthritis, asthma, bipolar disease, gastroesophageal reflux disease, cholelithiasis, and polycystic ovarian syndrome presents with tremors and twitching. She says that she might have mixed up her meds last week at which time she started having an irregular coarse tremor, motor agitation, weakness, ataxia, and sluggishness. She doesn't remember what meds she's normally on. Review of systems is notable for nausea, vomiting, and diarrhea. Exam shows sinus bradycardia and hypotension. Labs show a leukocytosis.
Challenge: What happened here?
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