Mystery Case #2

(EXOTIC AND BIZARRE TOXICOLOGY AT ITS FINEST)

HISTORY

The patient is a 60 year old man with an unknown medical history. Found wandering confused on a busy city street. It took 6 police officers to restrain him, and he was brought into the ER in four-point restraints. Nothing is known of his medical history.

PHYSICAL

• General: The patient is confused, combative, oriented only to person.
• Vitals: BP=160/95 P=120 RR=26 T=97.0
• HEENT: NC/AT, PERRL, EOMI
• Lungs: Clear to Ascultation Bilaterally
• HT: RRR, no murmurs
• Abd: non distended, no scars, no masses
• Rectal: (-)Heme
• Ext: Multiple bruises from restraints.
• Neuro: No focal deficits

DIAGNOSTIC STUDIES

• ABG- pH 7.39, pCO2 28, pO2 110, bicarb 24, 97% SaO2.
• Lytes: Na=145 K=4.0 Cl=104 HCO3=15
• BUN/Creat: 18/1
• Tox Screen: Negative for PCP, Amphetamines, Tricyclics
• Ethanol: Less than 10 mg/dL
• CPK: 750
• Serum Ketones 2+
• Urine: (++) ketones

CLINICAL COURSE

The patient was admitted with a preliminary diagnosis of:

1. Presumed Sepsis
2. Mental Status Changes

As the patient was nearing transport to the ICU, the nurse pointed out something in the room which had been missed... (Click here to see this finding)

Laboratory evidence reveals what toxin?

E-Mail me if you think you know the answer!! (all will be replied to!!)