Poisoning/Toxicity

[med__shots]

A 23 year old college student was brought by his friends from a party last night to the casualty department with headache and altered behavior. He is neither hypertensive nor diabetic. He is a smoker for the last 2 years, after joining the dorms. On examination, he is delirious and euphoric. BP is 190/110 mmHg, pulse 130/min and regular. There are no signs of meningeal irritation and planters are down going. The pupils are constricted and reactive to light. Blood sugar and creatinine levels are normal. EKG shows sinus tachycardia. What is the likely diagnosis?

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[TakotsuboOkazaki]

The casualty department. LOL.

Planters are down going. LOL.

Creative levels are normal. LOL.

Golden post. I will cherish it forever.

 

[Goro]

A 23 year old college student was brought by his friends from a party last night to a the casualty department with headache and altered behavior. He is neither hypertensive not diabetic. He is a smoker for the last 2 years, after joining the dorms. On examination, he is delirious and euphoric. BP is 190/110 mmHg, pulse 130/min and regular. There are no signs of meningeal irritation and planters are down going. The pupils are constricted and reactive to light. Blood sugar and creative levels are normal. EKG shows sinus tachycardia. What is the likely diagnosis?

Inability to do your own homework.

Dx: read Harrisons' and Katzung

 

[med__shots]

Inability to do your own homework.

Dx: read Harrisons' and Katzung

I study from Davidson. FYI, it was a past exam question and I can’t seem to get to the diagnosis.

 

[Angus Avagadro]

Whay are you considering? What's your differential?

 

[med__shots]

Whay are you considering? What's your differential?

Cocaine or cannabis but pupils are constricted

 

[Angus Avagadro]

Does it have to be one? Can it be mixed?

 

[Lawpy]

The casualty department. LOL.

Planters are down going. LOL.

Creative levels are normal. LOL.

Golden post. I will cherish it forever.

As if EM morale isn't already low enough. Calling it casualty department is sure fun

 

[mjl1717]

PCP could be in the differential.

 

[med__shots]

Has to be one drug

Does it have to be one? Can it be mixed?

 

[CleverAdvisor]

My guess is MDMA

 

[LunaOri]

As if EM morale isn't already low enough. Calling it casualty department is sure fun

That's what they call it in the UK.

 

[Phloston]

A 23 year old college student was brought by his friends from a party last night to the casualty department with headache and altered behavior. He is neither hypertensive nor diabetic. He is a smoker for the last 2 years, after joining the dorms. On examination, he is delirious and euphoric. BP is 190/110 mmHg, pulse 130/min and regular. There are no signs of meningeal irritation and planters are down going. The pupils are constricted and reactive to light. Blood sugar and creatinine levels are normal. EKG shows sinus tachycardia. What is the likely diagnosis?

Question on one of the newer Psych forms gives constricted pupils for PCP. Essentially everyone is like, "Wait, I thought PCP was supposed to be bellicosity and vertical/horizontal nystagmus." For this vignette, the fact that it presents as an otherwise "up" presentation and yet they specifically say his pupils are constricted, my gut is PCP here.

 

[Redpancreas]

A 23 year old college student was brought by his friends from a party last night to the casualty department with headache and altered behavior. He is neither hypertensive nor diabetic. He is a smoker for the last 2 years, after joining the dorms. On examination, he is delirious and euphoric. BP is 190/110 mmHg, pulse 130/min and regular. There are no signs of meningeal irritation and planters are down going. The pupils are constricted and reactive to light. Blood sugar and creatinine levels are normal. EKG shows sinus tachycardia. What is the likely diagnosis?

Focused Ranked DDx Includes:
1. Mixed stimulant toxicity-Adderall/PCP/MDMA +/- another (ex. Benadryl/EtOH because they couldn't sleep)
2. GABA withdrawal - EtOH/Benzodiazepines withdrawal. In real life that's a can't miss dx. Euphoria would be atypical.
3. Serotonin Syndrome albeit atypical because no medical history and no hyperreflexia. Euphoria would be weird too.

Euphoria + Adrenergic surge is a very specific constellation for stimulants (Amphetamine, MDMA, PCP) to the extent that I would see the pupils as a distractor. Add college student to that and for the boards that's pretty much a slam dunk. The constriction may be a distractor or in the explanations they may say something about how X% of stimulants are bought off illegal vendors increasing likelihood of it being laced. Also with any drug toxicity, there are phases and maybe pupils were dilated initially but are now more constricted for some reason.

Edit: Looked it up, people are saying PCP can present with pupil constriction. If this were the USMLE and they gave PCP and Amphetamines, I would put PCP.