Cases to be announced.

ACMT's National Case Conference (NCC) is a monthly webinar for ACMT members that features interesting cases seen by medical toxicologists nationwide.

Case 1: A 7-month-old girl is admitted after experiencing 2 weeks of upper respiratory symptoms. She has some mild language and motor delay and has a seizure on hospital day 4. Case 2: A 21-year-old woman develops shock four hours after overdosing on vitamins she purchased online. Case 3: A 43 year-old man presents for first-time psychosis and states he self-medicated his opioid withdrawal with OTC products one day prior. He develops rapidly worsening agitation, encephalopathy, tachycardia, and psychosis and requires sedation.

Case 1: A 30-year-old woman presents to the ED with a rash that started after she took a medication to treat a toothache. On arrival to the ED she is febrile and tachycardic. Case 2:​ A 62-year-old woman is found unresponsive and covered in vomit. On arrival to the ED, she is obtunded, hypothermic, and hypotensive. Case 3: ​A 3-year-old boy with developmental delay is found playing with a common household object. When his father realizes he has ingested almost half of it, he washes out the child’s mouth and brings him to the ED.

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.

The monthly webinar series continues with a presentation of cases seen by medical toxicologists nationwide.

Case 1: An 87-year-old woman presents to the ED after a self-harm ingestion. She complains of abdominal pain and nausea, and her initial electrocardiogram is abnormal. Case 2: A 12-year-old girl with a history of cerebral palsy presents to the ED for a fever that has been ongoing for 2 days and her mom is concerned that she is not at her baseline. Case 3: A 62-year-old man presents via EMS 2 hours after he was last known well. On arrival, his vitals are BP 60/40 mmHg, HR 104/min, and the patient is obtunded. His ECG demonstrates a QRS of 174 msec, with a QTc of 602 msec, and a prominent R wave in lead aVR.

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.

1. A 16-year-old girl presents to the ED after overdosing on medications she takes for rheumatoid arthritis. In the ED she has lightheadedness and runs of nonsustained ventricular tachycardia. 2. A 22-year-old man presents to the ED from prison after swallowing 50 bags of heroin and ten tablets of ecstasy. One hour after the ingestion, he is found unresponsive in his cell and requires naloxone. 3. A 66-year-old man presents to the ED with bilateral hand pain. He reports that earlier the same day he was cleaning coins at his home.