ARJ
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A 28-month-old female has been living with her mother in a shelter for homeless women and children. She is brought to the Emergency Department in status epilepticus, which is stopped with intravenous lorazepam. She is placed on a cardiac monitor and a wide complex tachycardia is noted. The ventricular tachycardia reverts to sinus tachycardia after defibrillation is performed.
Her temperature is 38.5 C (101.3 F),
blood pressure is 120/80 mm Hg,
pulse is 195,
and respirations are 26.
Physical examination reveals a lethargic,
pale toddler with dilated and reactive pupils,
dry mucous membranes,
shallow respirations,
diaphoresis and brisk deep tendon reflexes. A urine toxicology screen is most likely to detect which of the following substances?
a)Barbiturates
b)Cocaine
c)Heroin
d)Marijuana
e)PCP
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| an
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e.PCP
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| ibraheem
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b. cocaine.
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| mani
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b)Cocaine but i m thinking about explanation for normal BP.
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| Rana Khan
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B.COCAINE
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| phuluong2k
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Cocaine too, but normal BP seem illogical
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| ARJ
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B. This patient's clinical picture is consistent with acute cocaine ingestion. Cocaine is a CNS stimulant that causes increased heart rate, hypertension and hyperactive reflexes. Other substances of abuse can cause cardiac arrhythmias and seizures but of the answer choices, only cocaine causes mydriasis or dilated pupils. Treatment is supportive and may include anti-arrhythmics, anti-hypertensives, cooling blankets and sedatives. Barbiturates (choice A) are CNS depressants and would cause hypotension, normal or constricted pupils and diminished reflexes. Other classic features of barbiturate overdose include ataxia, slurred speech and nystagmus. Heroin (choice C) is an opiate and would produce symptoms of CNS depression (hypotension, diminished or absent reflexes, hypoventilation, hypothermia) and constricted pupils. Other symptoms of opiate intoxication include nausea, vomiting, euphoria, seizures and coma. Marijuana (choice D) ingestion or inhalation causes relatively benign symptoms that include euphoria, hunger, tachycardia and injected conjunctivae. Pupils usually remain normal. PCP (choice E) is a hallucinogen that causes CNS stimulation (hypertension, tachycardia, brisk reflexes, hyperthermia). Other hallucinogens such as LSD and mescaline cause dilated pupils but PCP has an effect of constricting pupils. Seizures and coma are more common with PCP and intracranial hemorrhages have been reported.
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