A 15-year-old boy presents to the emergency department (ED) with a complaint of altered mental status that began a few days prior (per his mother) and has gotten progressively worse. On arrival, the patient is noted to be awake and oriented to person, place, and time. Bedside blood glucose is 100 mg/dL. His physical examination does not reveal signs of trauma and vital signs are normal. His heart and lung examinations are normal and his Glasgow Coma Score is 14 (E4, V4, M6). His pupils are equal and reactive. No neurologic deficits are noted on examination. He has disorganized speech and

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