Læknaneminn - 01.10.1996, Blaðsíða 96

Overdoses and poisonings: physiological responses
daughter has spoken of bugs all over the walls and has
seemed to be reaching for things in the air. On arrival
in the emergency room the girl is tachycardic, mildly
hypertensive, is reaching around with her hands as if
for things unseen around her, has warm, slightly red,
dry skin, and very quiet bowel sounds. No response is
observed to the administration of naloxone.
Case 3
A 16-year-old girl comes in by lifesquad with the
report via the squad from her family that she has been
depressed and has spoken of suicide. She is volunteer-
ing no information. However, her breath carries with
it a powerful odor similar to, but not quite like, garlic.
She is salivating and tearing profusely, has vomited in
the ambulance several times and once in front of you,
has constricted pupils which react minimally to light, is
noted on the monitor to have a pulse rate of 40 beats
per minute, and has incontinence o,f both urine and
feces while in the emergency departm'ent.
Case 4
A 26-year-old woman is brought in by her husband
and admits she has been depressed and taken an over-
dose of pills. She says she tool a whole bottle of “Mini-
Thin” diet pills, but does not know what is in them.
Her husband volunteers to go back td their home and
get the bottle. No information is available from the
PDR. Meanwhile, the patient has dilated pupils at
8mm which are symmetric and reactive to light. She is
hypertensive and tachycardic, apparenjtly without her
control, and she is extremely anxious. She asks you if
she is going to die. Also, she reports that she has a hea-
dache.
Case 5
A 3-year-old boy is brought in by his mother to a
rural emergency department with the complaint that
shortly after drinking at least a swallow from a liter
Coca-cola bottle filled with clear liquid out in the gara-
ge he vomited several times and since has developed
this funny twitching of his arms and legs. On presenta-
tion he is tachycardic and hypertensive, and appears to
have a fine tremor in his arms and legs. Ipecac is given
followed by vomiting in less than 15 minutes. A dose
of activated charcoal premixed with sorbitol is given.
The patient seems to behaving normally per physician
and parent, and is discharged home at 2 hours post-
ingestion. Two hours later the mother returns with the
same child who is now lethargic, limp, opens eyes and
withdraws ail extremities to pain, but fails to respond
verbally. The mother says her husband came home
between the two ER visits and told her that the bottle
in question is the one he spits into when he plays ba-
seball.
Case 6
A 26-year-old man comes in by lifesquad. He was
fqund in an alley unresponsive but breathing with a
pulse. On arrival he is noted to be breathing very slow-
ly and deeply. His pupils are constricted and react
minimally to light. When given a noxious stimulus, he
would not open his eyes but would wince and give a
short moan, and did withdraw all four extremities to a
slight extent. His extremities were noted to have small,
circular scars and it was difficult to obtain intravenous
access.
0VERD0SES AND P0IS0NING:
PHYSIOLOGICAL RESPONSES
Case 1
This history and presentation are fairly classic for
withdrawal, more likely to the ethylchlorvynol than to
the butalbital (in Fiorinal), as the latter is commonly
used chronically in migraine patients without signi-
ficant withdrawal symptoms on removal. The patient
was placed on phenobarbital and was completely lucid
after receiving the fourth dose.
Case 2
On further questioning the mother related that she
found an empty bottle of diphenhydramine in the bat-
hroom. This patient provides an excellent illustration
of the anticholinergic toxidrome. Her mental status
gradually returned to normal and she was discharged
24 hours after admission.
Case 3
This case illustrates an ingestion of organophosphate
pesticide characterised by a muscarinic toxidrome.
These patients can literally “drown” in their own secre-
tions because of the degree of Bronchorrhea which can
occur.
LÆKNANEMINN
86
2. tbl. 1996, 49. árg.