It is normal to have patients to present with agitation to the emergency department. The history could be suggestive of the diagnosis in most. When an apparently healthy young man comes to the hospital agitated, without any history of fever or trauma, it is not an easy one to diagnose. This is a case report of a 35 year old gentleman who presented with such a history and the final diagnosis turned out to be a usual disease. Hence any patient presenting with neurological manifestations as agitation, one should consider cardiac causes such as Infective Endocarditis if no other obvious cause is found initially. Case reportA 35 year old unemployed Caucasian gentleman was brought to the emergency unit of a University Hospital by ambulance in a agitated and combative state. He was an insulin dependent diabetic and his blood sugar was always brittle. He smoked 5-10 cigarettes a day and drank alcohol in moderate quantity. His mother was a tablet controlled diabetic with good glycemic control. It was impossible to do any observations or examine the patient. The family physician letter said patient is a diabetic on insulin and he had history of misuse of amphetamines. The patient was accompanied by his mother. Mother stated that the patient had flu like symptoms for a week and hence was staying with her.On the day of presentation, he woke up from sleep feeling unwell and complained he had pain all over the body. He was taken to his family physician, who gave a referral letter to nearby hospital. On the way to the hospital in the car, he started becoming agitated and irritable. Mother felt he was going into hypoglycaemia. She called an ambulance. When the ambulance crew reached there, his BM was 1.5 mmol/L. They gave him 350 mls of 10% dextrose IV. His BM came to 20, but his clinical situation remained the same and later they brought him down to the emergency unit. Mother acknowledged that he does take recreational drugs. But she felt, in the preceding week, when he was with her it is very unlikely that he had been taking anything.In the emergency unit his temp was 37.3c. His pupils were 4-5 mm in size reacting sluggishly to light, GCS was worked out to be 11 (M5, E4, V2). No other clinical examination was logistically possible.Based on the history of intake of amphetamine, a working diagnosis of amphetamine overdose was made. Bloods samples were taken for all routine tests; toxicology screen and arterial blood gases were also performed. He was given diazemules IV in 2.5 mg alliquotes to a total of 10 mgs. A further dose of Haloperidol 5 mg IM was also given without much effect. More than an hour had passed by