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Emergency Medicine News

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Drugs May Be Different, but Treatment Is the Same

Fadial, Tom MD

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doi: 10.1097/01.EEM.0000526944.50496.06
    Figure
    Figure:
    Pharmacology, toxicity, and management of second-generation antipsychotic (SGA) overdose. (CNS Drugs 2012;26[7]:601.)
    Figure
    Figure

    A 38-year-old man with an unknown medical history was brought in after he was found unresponsive next to an empty bottle of Seroquel. His presenting vital signs were notable for a blood pressure of 96/43 mm Hg and a heart rate of 103 bpm. Examination revealed a tentatively protected airway (GCS E2 M5 V3, SpO2 100%, RR 14), normal pupil diameter and reactivity, and dry mucous membranes with thick vomitus in the oral cavity.

    Table
    Table:
    Toxidrome Summary

    The laboratory evaluation was unremarkable, with no evidence of aspiration on chest radiography. An ECG showed sinus tachycardia without QT prolongation. His blood pressure increased to normal range with fluid resuscitation. The patient's mental status progressively improved, and he was discharged after six hours of uneventful, continuous cardiac monitoring.

    How to Evaluate

    • POC glucose
    • ECG (QT interval)
    • Serum acetaminophen, salicylate, EtOH level
    • Serum drug levels if known (anti-epileptics)
    • Urine toxicology screen
    • Chemistry (metabolic acidosis, electrolytes, renal function)
    • LFT (hepatotoxicity)
    • CK (rhabdomyolysis)
    • Serum osmolarity (osmolar gap)
    • UA with microscopy (crystals in ethylene glycol poisoning)
    • ABG (carboxyhemoglobin, methemoglobin)
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