Dr. Paul A. Bergl, an intensivist passionate about diagnostic reasoning, joins Dr. Meghan Nothem, a Pulmonary & Critical Care Medicine fellow. They analyze a perplexing case of a 50-year-old man found unresponsive. Topics include the nuances of diagnosing acute encephalopathy, with emphasis on patient history and systemic causes. They explore lab and imaging findings, the implications of metabolic disorders, and the challenges of toxic alcohol intoxication. Their discussion highlights the importance of critical thinking and collaboration in complex medical scenarios.