A Costly Way to Get a Cheap High

​BY KATIE TAUSCH, MD; ELAINA CLARK; KIMBERLY KRESS GETZINGER, MD; SHANNA C. JONES, MDA 25-year-old man with a history of depression and narcotic abuse presented to the ED seven hours after ingesting 200 loperamide 2 mg tablets. He was found unresponsive at home. He was somewhat somnolent but oriented on arrival.His blood pressure was 76/43 mm Hg, pulse rate was 62 bpm, respiratory rate was 20 bpm, temperature was 35.7°C orally, and SpO2 was 98% on room air. His physical examination was otherwise normal. He said he took the loperamide "to get high and relax." He normally took 150–200 loperamide tablets every other day to offset withdrawal symptoms. A 12-lead ECG was obtained on arrival (Fig. 1), and poison control was contacted immediately.The patient's initial 12-lead ECG demonstrated a wide complex rhythm at 64 bpm, QRS of 190 ms, and QTc of 672 ms. The patient was given naloxone without much response, and intravenous fluid resuscitation was initiated. He was placed on a bicarbonate infusion, and his electrolytes were supplemented. The patient remained bradycardic and hypotensive, so he was also started on a dopamine infusion and 20% lipid emulsion infusion.Initial emergency department ECG.The patient's urine drug screen was positive for cocaine, marijuana, and benzodiazepines. Lab work revealed lactic acidosis and acute renal failure. The patient was admitted to the ICU and converted to a normal sinus rhythm approximately 23 hours later. (Fig. 2.) T...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research