Delayed GI Symptoms and a Liver Transplant

​A 16-year-old boy presented to an emergency department in rural Pennsylvania for nausea, vomiting, and diarrhea. He reported diffuse abdominal cramping that had started two hours earlier. Shortly prior to arrival, he had multiple episodes of nonbloody diarrhea and emesis. He had no significant past medical history, and was not currently taking any medications or supplements. Initially, the history he gave was limited due to a language barrier. His sister was also being evaluated for similar symptoms.The boy's vital signs were a heart rate of 130 bpm, a blood pressure of 100/50 mm Hg, a respiratory rate of 26 bpm, an oxygen saturation of 100% on room air, and a temperature of 98.9°F. His abdomen was diffusely tender, he was tachycardic with no murmurs, and his lung sounds were clear. His neurologic exam was significant for drowsiness, but he had no focal deficits, clonus, or rigidity. His mucous membranes were dry, and his pupils were normal with no scleral icterus. Treatment was started with IV fluids and ondansetron.His lab results were remarkable for a white blood cell count of 20, a lactic acid of 3.5 mg/dL, a potassium of 2.8 mmol/L, an anion gap of 14 mEq/L, an AST of 200 U/L, and an ALT of 350 IU/L. Abdominal imaging showed no acute findings.The differential diagnosis included acetaminophen toxicity, supplement ingestion such as comfrey, germander, kava kava, or pennyroyal, acute ethanol poisoning, hydrocarbon ingestion or inhalation, and mushroom poisoning.Identify...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs