prasannakumar
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20) A 17-year-old girl is brought to the emergency department after being found unresponsive by her parents. Her father reports that she has been very depressed over the past few weeks over a break-up with a boy. The father describes the daughter as being isolated and spending much of her time alone in her room. When she failed to get up for school, the father went into her locked bedroom and found her face down and barely breathing on her bed. An EMS team gave her a narcotic antagonist, IV dextrose solution, and IV fluids. In addition, her trachea was intubated for airway protection before she was brought to the emergency department. On physical examination, her pupils are 8 mm bilaterally and minimally reactive. Her abdomen is markedly distended. An urgent urine and serum toxicology screen reveals the following data: Urine
Benzodiazepine Positive
Opiates Positive
Serum
Diphenhydramine 790 µg/L
Ref. range: not defined; toxic: >200 µg/L
Ethanol 2987 µg/L
Ref. range: not defined; toxic: >1000 µg/L
Olanzapine Present
Which of the following ingested substances will most likely threaten the patient's life within the next 24 hours?
A. Benzodiazepines
B. Diphenhydramine
C. Ethanol
D. Olanzapine
E. Opiates
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| Hotobhaga
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ethanol.Acute alcoholic hepatitis
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| doc_clotaire
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B. Diphenhydramine
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| prathapdoctor
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I will go for B, because its cardiotoxic parasympatholytic effects.
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| usmlestud
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agree with B
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| arlete
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B
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| young_doc
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I'll have to go with A. Benzo...
especially with all that EtOH in her system
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| Hotobhaga
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Pt is intubated.. hence unlikely to die of resp depression in the next 24 hrs. diphenhydramine will be correct if the dose is very high. anybody knows what is the toxic dose for diphenhydramine poisoning. I know it is very rare. 0.74% mortality i read somewhere.
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| dr in trouble
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I wanted to say Oppiates but bcoz pt is intubated so not opiates and i m not sure for any of the other choices.
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| prasannakumar
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ans is B....Diphenhydramine....bcoz of the danger of arrythmias
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