A 76-year-old woman is brought to the emergency room after she became lightheaded while shoveling the snow in her driveway. She went inside her house, lied on the couch and slowly became unresponsive to calls or touch. Her current medications include aspirin for arthritis, sertraline for depression, oxycodone prn for severe back pain and levothyroxine for hypothyroidism. Family reports that the patient has been taking her medications fairly regularly till she had a bout of upper respiratory tract infection 10 days ago. Her vital signs are: temperature is 76°F, heart rate is 47 beats per minute, respiratory rate is 8 breaths per minute, blood pressure is 70/40 mm Hg, and oxygen saturation is 84% on room air. On physical examination, you notice a dull and apathetic facial expression, periorbital edema, macroglossia, delayed deep tendon reflexes, She did not respond to your commands or touch. Her hair is coarse and dry with the eyebrows missing the outer one-third of the hair. Skin looks yellowish, dry with a thickened and doughy feel. Laboratory findings are significant for hyponatremia, hypoglycemia, and myoglobinuria. Which of the following is the most likely diagnosis in this patient?
