CASE #4

HISTORY

A 25 year old male is transferred from the local prison because of generalized seizures. A brief transfer note sent with the patient states he had one seizure in his cell, and then two more within a span of 30 minutes. He was given 10mg diazepam IV in the prison infirmary prior to his transfer. En route to the ED, the patient suffered one additional seizure in the ambulance.

PHYSICAL EXAM

• General: Post-ictal, responsive to painful stimuli
• Vitals: BP=150/110 P=110 RR=24 T=98.5
• HEENT: NC/AT; Pupils midrange, reactive, no nystagmus
• Neck: Supple, no deformity
• Lungs: CTA
• Ht: RRR S1S2, no murmurs
• Abd: Soft nontender, no scars
• Ext: No cyanosis, good pulses, no needle tracks
• Neuro: No focal findings

DIAGNOSTIC STUDIES

• CBC: WBC=18K H/H= 16/48
• Lytes: Na=140 K=4.9 Cl=100 HCO3=7
• BUN/Cr: 20/0.9 Glucose= 120
• ABG: pH=6.99 PO2=112 PCO2=45
• Tox screen: pending
• ECG: Sinus tach, no ectopy, no ischemia
• CXR

Toxin and Discussion References