5 Quick Tox Cases

Well I am just back from Sydney – SMACC2013.  It was heaps of fun, and I got to meet a lot of my FOAMy heroes, long time collaborators and heaps of you folk that read this.

SMACC will be slowly trickled out over the ether in the coming months so you can enjoy it all and see what you missed – don’t worry there is a SMACC2014 in Brisbane – watch this space.

I will do my best to let you know when and where the SMACC material is released – or you could just sign up to Twitter and follow the guys who put the whole shebang together.   OK enough ramble.

This week I am giving not 1, not 2…  but 5 cases in a single hit.   It is a toxidrome showdown.  Imagine you are in a medium-sized ED when these 5 characters all present.  Here is what I want form you for each case…

A)  Name the toxidrome (or specific drug if you can)

B)  Outline what specific investigation you might consider

C) Outline in a few words your specific management plan – assume the basics are done.

The prize will be love and respect, I might even be able to get you one of 

Say no more  screen-shot-2013-03-05-at-7-28-19-pm


OK, here they are 5 cases – a quick background, Obs, Exam, ECG – and being Broome – there are no bloods etc available for now…  carry on.


60 yo man with chronic depression, usually managed by GP. Presents with GCS 8/15 after a seizure at home. He looks flushed, with dry skin. pulse – 120 in ST, BP 140/100, dilated equal pupils and a normal neuro exam. ECG shows sinus tachy with borderline wide QRS complexes.

45 yo man with chronic BPAD, usually managed in community by the mental health team. Well controlled symptoms recently. He presents with vomiting and 3 days of diarrhoea – he is complaining of abdo cramps. He looks dry, with sluggish cap refill, he has normal pupils, GCS 15, a fine tremor and a normal ECG

30 yo woman with borderline PD, multiples ODs in the past. Presents with syncope, nausea and dyspnoea at rest. BP 80/40, pulse 38 brady. She has bibasal creps (and US Kerley Bs) Neuro exam shows myoclonus in the limbs. ECG shows a 2nd degree block with 3:1 conduction. Her BSL is 18 mmol

A usually healthy, happy 23 yo woman. Presents with agitation, feeling thirsty and anxious. She also reports diarrhoea. She has dilated pupils, temp = 37.7. She is sweaty with a pulse of 120/min. Neuro = 4 beats of clonus in the legs. ECG = sinus tachy

This is a 50 yo man with chronic schizophrenia on a community-treatment order. Receives a depot every 2 weeks. HE is brought in as he is mute, staring and has developed incontinence. Pulse= 110, BP 160/110, temp = 38.8 He is sweaty, pale and drooling. Neuro shows increased tone, but blunted reflexes. ECG is normal



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