Missed Diagnoses and Misleading Drugs

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ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

1. A 16-year-old girl arrives by EMS after a seizure following an ingestion possibly including “a heart medicine, a depression medicine, and a sleep medicine.” She has an abnormal rhythm on the cardiac monitor. 2. A 25-year-old woman presents with nausea and vomiting after taking an overdose of a supplement roughly 13 hours earlier. Vital signs: BP, 119/81 mmHg; HR, 130/min; RR, 18/min; T, 98.9 F; SaO2 100% RA. 3. A 49-year-old man presents 2 hours after being bit by a black widow spider. Minutes after the bite he began experiencing severe pain to his legs, back and abdomen and complaining of muscle spasms. VS on arrival: BP 207/97, HR 77, Temp 97.9F, SaO2 96% on RA.

1. A 60-year-old man presents to the ED after a snakebite to the ankle. He has rapid cardiovascular decompensation, progressing to cardiopulmonary arrest. 2. A 38-year-old Eastern European woman and a 59-year-old South Asian man present independently to the ED with the sudden onset of vomiting, diarrhea, and abdominal pain followed by acute hepatic injury. 3. A 13-year-old boy with spasticity for which he has an intrathecal baclofen pump presents with myoclonus and agitation. His vital signs are: BP, 136/77; HR, 107; RR, 19; T, afebrile.

Presented by Adam Algren, MD Associate Professor of Emergency Medicine and Pediatrics, Truman Medical Center/Children's Mercy Hospital.