Warning Signs in Acute Toxicity of an Uncommon Drug

​BY ARJUN BHARADWAJ; CHRISTOPHER RUSSELL; MARGARET GAVOR, MBCHB, MPH; & KHALID MALIK, MDA 63-year-old man presented with hand tremors, dizziness, and expressive aphasia. His symptoms had started a month earlier, and this was his third visit to the ED for these symptoms, though the aphasia was a new symptom. He said his symptoms had been growing worse.The patient's symptoms had been previously attributed to alcohol intoxication. He also said he had been experiencing vomiting, dry heaving, bilateral tinnitus, and dizziness but no fever, chills, chest pain, abdominal pain, shortness of breath, vision and hearing problems, gait problems, vertigo, numbness, or loss of consciousness. He had had multiple falls due to dizziness but no head or neck trauma. He occasionally had constipation but no other symptoms.His history included right leg deep vein thrombosis, left shoulder replacement, epilepsy, anxiety disorder, panic attacks, and benzodiazepine and opiate dependence. He had been in a methadone program for 25 years for heroin abuse, but he had stopped all benzodiazepines a month before his ED visit because his primary care physician advised him not to mix them with alcohol. His medications were alprazolam, cholecalciferol, phenytoin, folic acid, meclizine, and naproxen. He reported daily alcohol and cannabis use.His temperature was 98.3°F, pulse was 75 bpm, respiration rate was 20 bpm, blood pressure was 167/108 mm Hg, and oxygen saturation was 98% on room air. The patient ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research