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A 58-year-old man presented unresponsive following a seizure at home. His brother stated that he became progressively confused over the course of a few hours and then started shaking. EMS reports tonic-clonic seizures that resolved following administration of 5 mg of midazolam IM. The patient was unresponsive and hyperthermic on arrival. He was intubated for airway protection, covered with ice packs, and administered normal saline intravenously. His rectal temperature is 41.9˚C (107.4˚F), blood pressure is 94/45 mm Hg, heart rate is 160 beats/minute, and the respiratory rate is 16 breaths/minute with an oxygen saturation of 96% on 100% FiO2. The skin is diaphoretic with no signs of trauma. The pupils are 3 mm in diameter and reactive. He has no response to noxious stimuli, and his reflexes are 1+ bilaterally. The remainder of the exam is unremarkable. The brother reveals that the patient has been prescribed olanzapine, tizanidine, diflunisal, and gabapentin, and he had recently used cocaine. Of note, the ambient temperature on this mid-July day is 89°F. His initial ABG demonstrates a pH of 7.28, CO2 of 41.5, pO2 of 140.6, HCO3 of 19, and lactate of 6.1. His CPK is 2,038 with a troponin of 9. The patient is in acute renal failure with a creatinine 3.1. A urinary drug screen was positive for benzodiazepines and cocaine. Non-contrast head CT is unremarkable. What is the differential for toxin-induced hyperthermia? Managing Toxin-Induced Hyperthermia ...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs