Law enforcement officers requested your assistance with a 24-year-old male who is acting aggressively. He has removed his clothing, is shouting, and throwing heavy furniture around in his apartment. Law enforcement tells you he has a history of diabetes and cocaine use. You should suspect:

• A. Hyperglycemia.
• B. Excited delirium.
• C. Thyroid storm.
• D. Schizophrenia.

Answer: (B)

Excited delirium is an acute, dangerous state of extreme agitation and combativeness that often occurs with stimulant use, such as cocaine. The described behavior—aggression, undressing, shouting, and throwing objects—in a patient with a history of cocaine use fits this pattern, where autonomic overactivity and disinhibition drive dangerous behavior and potential rapid deterioration.

Hyperglycemia or diabetic ketoacidosis would usually present with dehydration, thirst, frequent urination, abdominal symptoms, and characteristic breathing changes, not abrupt, violent outbursts. A thyroid storm would involve fever and severe tachycardia in someone with thyrotoxicosis, but it’s less likely in this acute, stimulant-associated scenario. Schizophrenia describes a chronic psychotic process with delusions or hallucinations rather than an abrupt, stimulant-related agitation episode.