TOXICOLOGY

Toxicology cases can be some of the more challenging cases that present to the emergency department (ED). Often the patient is altered or there is minimal history available. Many cases involve the combination of more than one toxic ingestion or exposure which can lead to a complex clinical picture.

The patient is a 33-year-old female with a medical history of ADHD and depression presenting with altered mental status. Per emergency medical services (EMS), the patient’s friend called for an episode of unresponsiveness. The patient’s ability to provide history is limited, but the friend reported that shortly prior to this event, the patient ingested a “pill” which he believed to be alprazolam (a medication she is prescribed). While awaiting evaluation, the patient had witnessed seizure-like activity in the waiting room, lasting approximately 30 seconds and was brought to a critical care room.

While opiates have been utilized for thousands of years, Opioid Use Disorder (OUD) has been increasing drastically since the turn of the 21st century…

Is crotalidae immune F(ab’)2 (equine) antivenom (Fab2AV) better than crotalidae immune polyvalent Fab (bovine) antivenom (FabAV) in preventing late hemotoxicity in patients who have been bitten and envenomated by rattlesnakes?

A 15-year-old female with a history of depression and ADHD who presents to the ED after an intentional overdose. Family notes that the patient is prescribed Prozac and Adderall, but they also found Benadryl and Ibuprofen in her room. On arrival, the patient was hypertensive to 140/82 and tachycardic…

A 16-year-old male with autism was brought to the emergency department after his mom found him confused and cyanotic. Patient arrived with a GCS of 14, was difficult to arouse, and had central cyanosis. Pulse oximetry read 85% despite adequate respiratory effort and clear lung sounds. The patient’s oxygen saturation did not improve despite appropriate supplemental oxygen therapy…

A 17 y.o. female with PMH significant for ADHD, anxiety, and depression presents to the Children’s Hospital Emergency Department with a chief complaint of vomiting, accompanied by her mother. She states that she has been vomiting for two days. Since that time, she has lost count of the number of times she has vomited. She denies seeing red or black in her emesis and tried taking Pepto-Bismol but vomited the medication.She was able to shower once which helped a little…

A 30-year-old female with a history of bipolar disorder presented after intentional lithium overdose. The patient reported feeling increasingly depressed for several weeks with intermittent suicidal thoughts. She reported getting into a verbal altercation with family while drinking alcohol and subsequently ingested a nearly full bottle of lithium (approximately 40 tablets, each with a concentration of 300 mg). She reported mild blurred vision and anxiety, but otherwise denied any other subjective complaints…

A 34-year-old male presents to the emergency department from his urologist’s office after exhibiting word-finding difficulty and confusion during an elective surgery. He had previously been feeling well and is otherwise healthy. Per discussion with his urologist, the patient reported continued discomfort during the procedure, so he was given additional lidocaine until his pain was sufficiently managed. He developed symptoms that progressed from dizziness to word-finding difficulty and confusion. It was subsequently noticed that he had accidentally been treated with 2% lidocaine without epinephrine instead of 1% lidocaine without epinephrine, thus doubling the intended dose…

A 4 month-old ex-full term infant presents to the ED unresponsive. He is immediately brought to the trauma room and history is gathered from his mother…

A 16 year-old male presented to the emergency department after intentional overdose of 200 mg of baclofen. The patient was found in his bedroom by family members approximately 10 hours after ingestion with reported twitching, vomiting, unresponsiveness, and possible seizure activity. On arrival to the emergency department, the patient was awake, alert, and oriented; tearful, but otherwise asymptomatic…