NEW CASE - SUMMARY
Unconscious Museum Worker

Robert Hoffman
New York City Poison Center
New York, NY

January 1998; 1(1): 3


See also  CASE DISCUSSION - 1998; 1(1):4,   FURTHER HISTORY 1998; 1(2):16

 A 38 year old white male with a history of depression was brought to the emergency department (ED) by paramedics after he was found unconscious following a suicide attempt. Upon arrival in the ED he was cooperative but lethargic while using a 100% oxygen nonrebreather mask. In his bookbag he had a one pint rum bottle. Occupational history revealed that he worked in a local museum, but the patient was too lethargic to give details of his job.  

His physical examination revealed a temperature of 97.3 degrees F, a pulse of 69 beats/minute, a blood pressure of 124/84 mmHg, and a respiratory rate of 14 breaths/minute. He was a well developed and slender male without any evidence of physical trauma. His head was normocephalic and atraumatic. His extraocular motions were intact without nystagmus and his pupils were 4 mm, round and sluggishly reactive to light. His oral mucosa was moist with no lesions or ulcers and his neck was supple. He had clear lung fields bilaterally and his heart examination revealed a regular, bradycardic rhythm without murmurs or rubs. His abdomen was soft, nondistended and nontender with normal, active bowel sounds. His skin was warm and dry without flushing or cyanosis. He was slightly lethargic with labile emotions. His reflexes were normal without clonus and he had symmetrical and intact muscular strength.

Approximately 15 minutes after his arrival in the ED, the patient became rapidly unresponsive with decreased respiratory effort and required emergent orotracheal intubation. Midazolam (2 mg IV) and succinylcholine (150 mg IV)
were used as pharmacologic adjuncts. Paralysis was continued using vecuronium (10 mg IV) and intermittent doses of lorazepam (1-2 mg IV) were administered for sedation.

Initial laboratory tests revealed: sodium, 141 mmol/L; potassium, 4.0 mmol/L; chloride, 106 mmol/L; bicarbonate, 18 mmol/L; blood urea nitrogen, 8 mg/dL; creatinine, 0.9 mg/dL; glucose, 122 mg/dL. An electrocardiogram showed sinus bradycardia at 50 with normal intervals. Qualitative toxicologic analysis was negative for acetaminophen, various drugs of abuse, sedative hypnotics, and opioids. An ethanol level, drawn on presentation, was 22 mg/dL. A radiograph of the bottle is shown below.

References

Daffner RH, Jimenez JP: The double gastric fluid level in kerosene poisoning. Radiology 1973;106:383-384.

Dally S, Garnier R, Bismuth C: Diagnosis of chlorinated hydrocarbon poisoning by x ray examination. Brit J Indust Med 1987:44:424-425.

Readers are encouraged to send their comments and diagnoses to bobhoff@pol.net. Please refer to the case by number and try to keep comment to under 100 words. Readers opinions will be anonymously tabulated and published along with a discussion in the next issue of IJMT.

If you have a case you would like to submit, please send the clinical information and the appropriated image (photograph, x-ray, or ECG) to: 777 E. Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820. Images (as tif,gif, jpg files) and clinical information may be sent by e-mail to bobhoff@pol.net. If the image shows an actual patient or part of a patient's body, please include a cover letter indicating that the paitent has given you permission to take and use their photograph.

 



January 1998; 1(1): 3

This article is located at http://www.ijmt.net/ijmt/1_1/1_1_3.html

Quick Survey
Please rate this article:
1 2 3 4 5
(5 is best)
Comments?



IJMT Home | Current Issue | Past Issues | Search | Technical Support | Send Comments to ACMTNet

Copyright 1999-2003, American College of Medical Toxicology.