Toxicology Case Report
History
M/19Known history of ecstasy/ketamine abuse.Found staggering in a shopping plaza in a
September afternoon.Police was called.Became unconscious en route to hospital.
Physical findings
GCS 7/15 (E1V1M5)BP 108/58 Pulse 78/minRR 10/minSpO2 97% Room AirTympanic temp. 36.6 CHb 13.5 g/dlH’stix 5.5 mmol/l
Physical findings
Pupils equal, 2mm sluggish to lightNeck softHeart sounds dual. No murmurs.Chest was clear. Shallow breaths. Abdomen soft and non-tender.
BS normal. No mass felt.Spontaneous 4-limb movements noted.
Physical findings
Incidental finding of 2 packets of white powdery substance beneath the underwear.
Police summoned to collect the packets.
Physical findings
ABG taken.pH : 7.31pCO2 : 7.7PO2 : 67.6 (100% O2)HCO3 : 28Na/K : 146/4.3
Physical findings
ECG : Sinus rhythm 78/minCXR : unremarkable
Diagnosis ?Diagnosis ?
Ecstasy overdose?
For:Ataxia
Against: NOT hypertensiveNOT tachycardicNOT hyperthermicNOT mydiatricNOT agitated
Ketamine overdose?
For: respiratory
depression(severe cases)
Against:NOT hypertensiveNOT tachycardicNOT mydriatic
Tentative diagnosis :Tentative diagnosis :
Opioid overdose
Progress
IV Naloxone was given Unresponsive with GCS 7/15 despite 4.4mg
given in increments over 23 mins.Rectal examination unrevealing.
Progress
Trial of IV flumazenil 0.5mg given.Fully conscious 2 mins. afterwards
Progress
Conscious and well after admission to medical ward.
Part time mobile phone salesman.Claimed occasional use of ketamine and
ecstasy.Denied other drug use.Discharged the next day.
Benzodiazepine overdose
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