Christine Murphy

Case 23 Withdrawal from Chronic Headache Medication

This chapter delves into the case of an 8-year-old male who develops withdrawal symptoms after a chronic headache medication is discontinued. Multiple withdrawal syndromes are reviewed, as well as general management principles of withdrawal.

Case 13 Thyroid Supplement Ingestion

This case involves a 2-year-old female who ingested some of her father’s prescribed medication. She presented early to the emergency department where she received activated charcoal. On a follow-up call from the local poison control center 3 days later, she had developed vomiting, agitation, and appeared to have increased work of breathing. We review possible causes for the patient’s symptoms including thyroid hormone toxicity, lithium toxicity, and management guidelines for her specific overdose.

Case 12 Acute Hepatitis

Many exposures can cause liver injury. This case involves a 46-year-old patient with fever, nausea, vomiting, and signs of hepatic injury. In this chapter, we review pharmaceutical and supplement causes of hepatitis and hepatocellular necrosis.

Case 19 Nicotine Toxicity

In this chapter, we discuss the case of a toddler who acutely vomited following ingestion of a small container of liquid on his father’s nightstand. He subsequently developed ataxia and lethargy. This chapter explores possible causes of his symptoms, including GHB intoxication and nicotine exposure.

Case 25 Hyperlactemia

In this case, an 18-year-old male presents to the emergency department with status asthmaticus. He subsequently developed hyperlactemia during the first 8 h of his hospitalization. This chapter reviews causes of hyperlactemia, including specific discussions on propofol infusion syndrome, toxic alcohol-related hyperlactemia, clenbuterol exposure, and mitochondrial toxins.

Case 5 Exotic Snake Envenomation

In this case, a patient is envenomated by his friend’s exotic pet snake. The patient rapidly develops signs of neurotoxicity, including blurred vision, ptosis, and difficulty swallowing. He ultimately develops respiratory arrest and bradycardia. In this chapter, we review some of the toxins that can cause progressive neurologic symptoms including botulinum toxin, neurotoxic snakes in the US, and some of the exotic snakes that can cause neurologic effects.

Case 27 Hepatic Injury from a “Cultural Medicine”

A 34-year-old female developed itching and jaundice after taking a “cultural medication” given to her by a friend. Laboratory studies from her initial emergency department evaluation suggest a cholestatic process. This chapter reviews herbal medications associated with hepatic injury and drugs that cause hepatic injury.

Case 17 Ultra-Rapid Opioid Detoxification

A 30-year-old male presented to the emergency department after undergoing ultra-rapid opioid detoxification. He was awake but nonverbal for the 8 h following the procedure. With this case, the process of and possible complications associated with ultra-rapid opioid detoxification are reviewed. Potential causes of the patient’s symptoms are reviewed, including carbon monoxide poisoning, ibogaine exposure, and spongiform leukencephalopathy.

Case 3 Diet Pill Ingestion in a Child

A 3-year-old male ingested several tablets of his mother’s diet supplement, which had been obtained from Mexico. While he did not develop clinical signs of toxicity, exposure to this product was concerning based on the active ingredient it reportedly contained. This chapter reviews some of the agents found in “diet pills,” how they cause toxicity, and clinical symptoms associated with toxicity.

Case 10 Status Epilepticus Following Recreational Drug Insufflation

A 21-year-old male presented to the emergency department in status epilepticus. He was hyperthermic, tachycardic, and hypertensive with hyperreflexia and clonus. Laboratory workup revealed a metabolic acidosis with associated hyperlactatemia. He was admitted to the intensive care unit where he was sedated, mechanically ventilated, and externally cooled. His hospital course was complicated by an aspiration pneumonia and rhabdomyolysis but he fully recovered.