Cases to be Announced.

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.

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.

1. An 18-year-old man presents to the ED after a self-harm attempt in which he ingested a metal bar he purchased online. 2. A 13-year-old healthy girl is brought to the ED after a witnessed cardiac arrest. Although there is no history of ingestion, EMS brings bottles of amoxicillin and diosmin/hesperidin. Post ROSC, her vital signs are BP, 143/75 mmHg; HR, 120/min. On the ECG, her QRS is 86 msec and her QTc 450 msec. 3. A 50-year-old man with OUD presents to the ED after a suspected opioid overdose. He receives several low-dose boluses of IV naloxone over several hours. Due to recurrent and prolonged respiratory depression, his is started on a naloxone infusion.

1. Two individuals separately purchase the same health supplement online. After the first use, they both presented to the hospital after reading the accompanying information. 2. A 49-year-old woman with pulmonary hypertension and AUD presents to the ED after a suicide attempt with her sildenafil and ambrisentan. 3. A 28-year-old man presents to the hospital for shortness of breath. He develops progressive hypoxia requiring high flow nasal cannula and his chest imaging is remarkable for diffuse ground glass opacities.

1. A 52-year-old woman with a complex past medical history presents to the ED for altered mental status and seizure-like activity. During her hospitalization, she has several cardiac arrests. 2. A 64-year-old man presents with multiple self-inflicted stab wounds, shock, and a possible history of ingestion. He is taken emergently to the operating room, where he develops persistent metabolic acidosis and has a brief cardiac arrest. 3. A 40-year-old male bodybuilder with a history of palpitations presents to the ED in respiratory distress with tachycardia, hypertension, tachypnea, and hypoxia.

1. A 70-year-old man with schizoaffective disorder and a recent viral illness presents to the ED from an assisted living facility with garbled speech, hypotension, and hypothermia. 2. An 80-year-old man with a history of alcoholic cirrhosis admitted for ascites has been on a flumazenil infusion for two weeks. He becomes sedated whenever the infusion is turned off. 3. A 49-year-old woman with a past medical history of schizophrenia presents to the ED with foot pain and altered mental status after recently being discharged from the hospital. Over the next 24 hours she becomes progressively more altered and nonverbal.

1. A 52-year-old man experiences cardiac arrest after an accident at a chemical plant. ROSC was obtained by EMS. He presents to the ED intubated and in a wide-complex tachycardia. 2. A 55-year-old man with a history of OUD, COPD, presents to ED in opioid withdrawal (COWS 17). Last use of opioid was 1 day earlier. He receives buprenorphine 32 mg over four hours. The patient becomes increasingly hypoxic throughout the night and is intubated for presumed pneumonia. 3. An 8-year-old boy presents after receiving “dipirona monoidratada” drops by his grandmother for fever. He is now complaining of abdominal pain.