A Weak Admission

​A 64-year old woman presented to the emergency department with nausea, vomiting, dry mouth, dry eyes, and difficulty keeping her eyes open. She admitted to eating mandarin oranges out of a can the night before, and at that time she thought they "tasted funny" but did not think much of it.​The next morning she noticed she was having trouble opening her eyes and that her mouth was dry. She looked inside the can of oranges and saw it was discolored.Her presenting vital signs were unremarkable. The patient was alert and awake. She had ptosis bilaterally, with mydriatic pupils unresponsive to light. The patient had dry mucous membranes with no oropharyngeal erythema or exudates. Her heart rate and rhythm were regular without murmurs. Her lungs were clear to auscultation, and her abdominal exam demonstrated no tenderness, but she became nauseous with palpation. She was able to move all four extremities spontaneously, and her deep tendon reflexes were intact. Initial labs included a CBC, BMP, hepatic panel, lipase, VBG, UA, and CT of the head, all of which were unremarkable.The Toxicologic DifferentialAminoglycosideAnticholinergicBuckthorn (Karwinskia humboldtiana)Botulinum toxinCarbon monoxideDiphtheriaElapid envenomationN-hexaneOrganophosphorus compoundsParalytic shellfish poisoningTetrodotoxinThalliumTick paralysisExogenous thyroid hormone in patients who develop thyrotoxic periodic paralysisScenarios of Botulism ExposureFoodborne botulism occurs after ingestion of...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs