Problem: A 36-year-old woman presents with drowsiness, confusion, nausea, and vomiting that began 6 hours ago. She is at 16 weeks gestation. Her history is significant for bipolar disorder and type 1 diabetes mellitus. Her medications include lithium and insulin. Her sister has Hashimoto thyroiditis. There is no history of alcohol consumption, smoking, or illicit drug use. Vital signs are blood pressure 110/64 mmg, heart rate 98 bpm, and respiratory rate 16 breaths/min. On physical examination, she is drowsy and confused, her thyroid is normal in size, and her abdomen is nontender and consistent with gestational age. The neurologic exam reveals a coarse tremor in the upper limbs and downbeat nystagmus. Laboratory tests show blood glucose of 150 mg/dL, WBC count of 10000/µL, BUN level of 22 mg/dL, and a normal coagulation profile. Which of the following coexisting conditions can lead to this presentation? A. Diabetes mellitus B. Hyperthyroidism C. Acute fulminant hepatitis D. Dehydration