24 year old female

AMS - BIBA from home, opens eyes to voice, not following commands but localizes painful stimuli, unintelligible sounds to command

BF at bedside says he thinks she "overdosed" on pills but he didn't bring anything from the scene and doesn't know the name of pills

T - 38C, HR - 130, BP - 112/83, POx - 98%-RA



















FS - 102

Pupils - 6 mm bilateral, equal, minimally reactive
MM - dry
Skin - hot to touch, not diaphoretic
Cardiac - RRR, tachy
Pulm - CTAB/L
Abd - soft, non-ttp













Diff Dx?














Overdose

• Anti-Cholinergic
• Cholinergic
• EtOH
• Sympathomimetic
  
• Sedative/hypnotic

Labs / Imaging / Workup

• Acetaminophen
• Salicyclate
• CPK
• UPreg
  
• EKG + cardiac monitor

Benadryl (diphenhydramine)

• Toxicity at 3-5 x daily dose
• Fatal at 20-40 mg/kg
• Cardiac abnormalities - 400-500 mg
• QT prolongation, hypoTN, tachycardia
  
• Seizures, rhadbomyolysis, coma, compartment syndrome
• Treatment
• Physostigmine
• Sodium Bicarbonate (QRS prolongation, myocardial depression)
• Lipid therapy