Bites, Breads, and Bad Fruits: Surprising Natural Toxins That Harm Your Kidneys

1. A 50-year-old woman presents to the ED with fatigue, diarrhea, and vomiting and the following vital signs: BP, 95/65 mmHg; HR, 35/min (sinus). An inpatient workup is unrevealing and she improves clinically, but returns 2 days after discharge with chest pain, shortness of breath and allodynia of the hands. Her husband had a similar presentation 1 week prior to the first visit. 2. A 60-year-old man with a past medical history of obesity presents to the ED after ingesting a month's worth of his diltiazem and metoprolol. 3. A 26-year-old man is brought to the ED intubated after being found obtunded at home. Three days later, he is extubated and is noted to have auditory hallucinations.

1. A 59-year-old male undergoes mitral valve surgery. After arrival to the cardiac surgical ICU, he develops shock, rigidity, and an elevated temperature. 2. A 61-year-old woman who lives in a trailer park presents to the ED with abdominal pain and bleeding. There is no clear etiology for either. 3. A 30-year-old man presents to the ED intubated following a seizure. Prior to the seizure, he walked into a police station with a plastic bottle and reported having ingested half of the contents.

This month's topic is Caustic Ingestions and Imaging. The articles will be reviewed by the Virginia Commonwealth University Program in Medical Toxicology, led by Dr. Brandon Wills.