To See or Not to See

A   A 17-year-old boy presented to the emergency department after having a seizure. Initial vital signs included a temperature of 38°C, heart rate of 134 beats/min, respiratory rate of 22 breaths/min, blood pressure of 142/93 mm Hg, and pulse oximetry of 97% on room air. His physical exam is significant for tachycardia and pupils are 5 mm bilaterally and reactive to light with horizontal nystagmus. He is awake, confused, and combative.   Paramedics report that his mother found him in his bedroom was acting strangely before he fell to the floor and began convulsing. ED staff administered 2 mg intravenous lorazepam, which caused his seizure to cease. The patient’s mother is in the room, and she says he has no history of seizures and is not taking any medications.   What are five eye manifestations that may be seen in an illicit drug abuser? n Nystagmus from interference with extraocular movements resulting from acute intoxication with: o Phencyclidine (PCP): Horizontal, vertical, or rotary nystagmus. These effects may also be seen with ketamine. Other common drugs associated with nystagmus include anticonvulsants (phenytoin, carbamazepine, valproic acid, lamotrigine, topiramate), ethanol, lithium, dextromethorphan, and lysergic acid diethylamide (LSD). n Impaired near-vision resulting from mydriasis o Acute intoxication of sympathomimetics (amphetamines, cocaine) and anticholinergic agents (TCA, diphenhydramine) n Talc retinopathy o Seen in patients who injec...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs