Whip It Good

A 29-year-old man presented to the emergency department with numbness and tingling of his entire body for three weeks. He said the symptoms started when he entered a drug rehab facility for benzodiazepine and opiate abuse, and that the last time he used either drug was more than a month ago. His initial vitals demonstrated a heart rate of 106 bpm, blood pressure of 115/70 mm Hg, temperature of 98.6°F, respiratory rate of 14 bpm, and SPO2 of 99% on room air.He is well nourished, alert, and oriented but anxious-appearing. His neurologic exam demonstrates no ataxia on ambulation with cranial nerves II-XII intact. His motor exam of upper and lower extremities is intact, and he has no evidence of dysdiadochokinesia. His patellar reflexes are 2+ bilaterally. He has slightly diminished sensation in all extremities. The rest of his physical examination is unremarkable. CBC, BMP and UA are within normal limits. A noncontrast head CT demonstrates no acute intracranial abnormalities.The Toxicologic DifferentialArsenicn-Hexane (in glue)Nitrous oxideCiguatoxinThalliumMedications including pyridoxine, amiodarone, tacrolimus, vincristine, thalidomide, paclitaxel, and nucleoside reverse transcriptase inhibitorsDrug-induced electrolyte (potassium and magnesium) abnormalitiesDrug intoxication leading to spinal cord or other physical traumaThe patient eventually admitted to abusing nitrous oxide for the past three weeks. He said he had been using an average of 50 cartridges a day. His reasonin...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs