So here's the scoop. I work in a small community hospital- a general ICU. The bottom line is- everyone- including our doc's are completely stumped. Here's the details...
57 y/o female
HX: HTN, depression, MI, cardiac stent x2, lap chole 2006, non-IDDM.
At home- house was treated for bugs- (bombed is what I got in report)
after approx 3 hours, EMS called by friend stating pt has a seizure.
Pt brought to ER- Combative, agitated, non-verbal, hypertensive (212/110), tachycardic (140-160's) kussmaul respirations, low grade fever (100.9). FSBS 236. BUN 21/creatinine 2.1
Pt transferred to PCU- continued HTN 200's/100's with PRN Hydralizine order. after 1 hour on PCU order to Tx to ICU- no order for Nipride or Labetalol.
Pt continued as above- pt appears diaphoretic- EKG- ST/SVT 150-160. Adenosine given- no response.
CT head- small white matter changes- appear chronic. NO ACUTE PROCESS SEEN.
Any ideas- nothing- not Ativan, Haldol, or Valium calmed her down. None of the doc's seem to have any ideas as to what is wrong with her. I consider myself pretty smart- but for the life of me- I can't figure this one out. we gave her Dilantin IV b/c they thought she may be having seizures- but honestly I don't think thats whats going on. Her ETOH and Tox were neg.
thanks for any input....
What about pheochromocytoma? This tumor can secrete excessive amount of epi and norepi. Besides the physical symptoms of elevated BP and HR they can get crazy too. Did you guys check her urine for catecholamine metabolites? Maybe the poison is an unrelated coincedence. But, antifreeze poisoning sounds pretty good too, especially since you said she was in Kussmal's breathing (due to a metabolic acidosis probably) and that she was in renal failure (kidneys's compensating for metabolic acidosis?). I agree with the others BP and Heart rate need to be controlled with something other than hydralazine.
Last edit by questionsforall on Apr 5, '10
: Reason: addition