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Case 33 year old male gradual onset of confusion, agitation distress; increasing over the past 6-12 hours recent GP visit for ? depression; question over possible recreational drug use (cannabis, ecstasy) On arrival in ED (RESUS) A- patent, protected B- RR 21/min; SpO2 98% OA ; clear chest C- hot to touch; HR 135 bpm; BP 160/100 mmHg D- agitated, restless, confused; pupils large (mydriasis) / Rigidity limbs, frequent myoclonic jerking movements / hyperreflexia; no meningism E- temp 38.2; no rash VBG - mild metabloic acidosis, lactate raised, glucose normal CXR normal ECG  What is the differential diagnosis?
What are the potential underlying causes? What is the treatment?
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