Fluoride

Standard 24-hr Observation Period in Bupropion Ingestions

Neurotoxins, Metals, and Medications

Missed Diagnoses and Misleading Drugs

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 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.

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.

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.