A 74-years-old man was admitted at our emergency department for syncope. His past medical history included hypertension, smoking, carotid and peripheral artery disease and hemodialysis for end-stage renal disease. The physical examination revealed aphasia, dysarthria and right-sided motor impairment. The blood pressure was 170/90mmHg, heart rate 89 beats per minute, respiratory rate 18 breaths per minute, oxygen saturation 97% in ambient air. Initial basic laboratory values were notable for potassium 5mmol/l, creatinine 9mg/dl, haemoglobin 9.3g/dl and serum glucose values of 303mg/d.
