Progressive multifocal leukoencephalopathy is a rare complication of immunosupression in patients who undergo organ transplantation, with a high death rate.
Fibroblast growth factor 21, an important regulator of glucose and lipid metabolism in muscle, is strikingly elevated in the serum of patients with mitochondrial respiratory chain deficiencies.
This issue might be subtitled "What will they think of next?" Getting high does not always require the purchase of illegal drugs, and all substances that alter sensorium, such as nutmeg, cannot be regulated. However, the emergency physician must remain aware of the latest fads of drug abuse, and should be able to recognize the symptoms they cause.
