Sponsored by MTF and Bayer

Metabolic Mayhem

Vitamin A Toxicity

Sponsored by MTF and Bayer

1. A 63-year-old man presents with loss of vision and 'fixed dilated pupils.' He is noted to have profound acidemia with elevated lactate, AKI, and hyperammonemia. He is given fomepizole and is hemodialyzed. 2. A 62-year-old man presents to the ED after ingesting diltiazem, acetaminophen, aspirin, bupropion, and amitriptyline in a suicide attempt. While in the ICU he becomes hyperthermic to 107F. 3. A 25-year-old man presents to the ED after he was found seizing in his car. On arrival he is agitated, has a seizure, and is intubated.

Sponsored by MTF and Bayer

Sponsored by MTF and Bayer

This month's articles will be reviewed by the Atrium Health Carolinas Medical Center Program in Medical Toxicology led by Dr. Erik Fisher.

Sponsored by MTF and Bayer

1. A 41-year-old woman presents with progressive leg swelling and a long-standing history of burning leg pain. 2. A 30-year old woman with nonverbal autism presents with 2 hours of recurrent syncope. 3. A 73-year-old man presents to the ED unresponsive following an intentional overdose of clonazepam. He is not protecting his airway, but he is DNR/DNI and family wants to respect his wishes.

This month's articles will be reviewed by the NYU Medical Toxicology Fellowship Program.

1. A 55-year-old woman presents with persistent nausea, vomiting, and diarrhea after taking a weight loss supplement that she purchased online. She arrives to the ED with the following vital signs: HR 73, BP 135/75, RR 24, SaO2 98% RA. Shortly after, her HR begins to drop into the 40s. 2. A 42-year-old man with a history of pituitary macroadenoma excision complicated by CSF leak returns to the ED five days later with encephalopathy and oliguric renal failure. 3. A 24-year-old man with a history of Crohn’s disease, depression, hypertension, and erectile dysfunction comes to the ED with sweating, tremors, “muscle tightening”, rapid heart rate (130s) starting 1-1/2 h after using a tanning product.

This enduring activity is designed to increase knowledge and change competency of Per- and Polyfluorinated Substances, PFAS (forever chemicals) practices, and strategies.

1. A 7-day-old boy in the NICU is receiving TPN and dopamine through a left forearm peripheral IV that is noted to have extravasated. This is suspected to have begun two 2 hours earlier. 2. A 30-year-old man is cleaning his saltwater tank when "something" gets in his eye. Four hours later he develops a fever, cough, and shortness of breath. 3. A 38-year-old woman on INH monotherapy for latent TB presents with RUQ abdominal pain. She is noted to have: AST 545, ALT 130, AlkPhos 156, nl bilirubin. A RUQ sonogram is negative.

1. A 56-year-old man with a history of diabetes, hypertension, severe restrictive lung disease secondary to covid pneumonia presents with one day of fatigue, dyspnea on exertion, dry cough, and hypoxia (79% at home pulse oximetry). Patient states the symptoms began acutely, two hours after getting home from work the day prior. He reports that a few other co-workers have similar symptoms as him or they have nausea, abdominal pain, vomiting. He thinks a virus is going around his workplace. 2. A 51-year-old man presents with a diffuse rash over the past 6 days that developed after he ingested a product for sexual stimulation called “royal honey” that he obtained at a local shop. His VS are normal and he is in no distress. 3. A 2-year-old girl is extracted from underneath debris from a structural fire; she was found covered in soot and is pulseless. CPR is initiated and ROSCis achieved within minutes. She arrives to the ED with the following vital signs: BP, 95/58; HR, 130; RR, 28; SaO2, 100% on NRB; T, 98.6F. She is only responsive to pain and is promptly intubated.

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.

Presented by Jerry W. Snow, MD, Department of Medical Toxicology, Banner University Medical Center-Phoenix.

Presented by Alicia Minns, MD, Fellowship Director, Medical Toxicology Fellowship, UC San Diego.

Presented by Nick Connors, MD, Associate Professor, Medical University of South Carolina.

GETUP International Case Conference is aimed at increasing toxicology education between centers with and without medical toxicology services through videoconferencing.