Lithium Overdose: The tale of a light metal and its skinny therapeutic index Chief Complaint: Lithium Overdose HPI: Patient is a 39-year-old male with a past medical history of schizoaffective disorder, alcohol abuse, and prior suicide attempt by drug overdose who presents today due to another suicide attempt. Patient states that his girlfriend recently passed…
Read MoreContributor: Don Stader, MD Educational Pearls: Toxic shock syndrome (TSS) is a rare cause of shock typically caused by Staph aureus or Strep pyogenes, that produces a toxin that leads to rapid onset hypotension with a diffuse erythematous rash. Signs of TSS may include rapid onset of altered mental status, dizziness, nausea, abdominal discomfort, hypotension,…
Read MoreContributor: Don Stader, MD Educational Pearls: Altered mental status/confusion are major symptoms associated with both alcohol use and withdrawal. Wernicke’s encephalopathy is a triad of symptoms of confusion, internuclear ophthalmoplegia, and confabulation The treatment for Wernicke’s is IV thiamine or vitamin B1 Untreated Wernicke’s leads to Korsakoff’s syndrome where a prolonged thiamine deficiency leads to…
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Taken from ‘UnfilterED #8: Dr. Christopher Hoyte’. “This current sars-coV-2 / COVID-19 situation should really be a wake-up call for not just a pandemic, but for a biological attack…One of the things I would like to do when we bring our attention back from COVID and get through this pandemic is to really start to…
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Dr. Chris Hoyte is an ED physician, toxicologist and researcher based in Denver, CO. He was featured in Bring Em’ All: Chaos. Care. Stories from Medicine’s Front Line, a book celebrating emergency physicians through personal testimonies and photography on the frontlines captured by legendary photographer, Eugene Richards. Time Stamps: 01:25 – Dr. Hoyte’s Origin…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Significant cyanide exposure most commonly occurs from fire/smoke exposure particularly when plastics are involved Cyanide binds to cytochrome oxidase leading to the use of anaerobic metabolism which causes a profound lactic acidosis Classic toxicity includes a rapid loss of consciousness, hypotension, bradycardia, respiratory depression, and seizures Mild exposures can…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Arsenic is a heavy metal that binds to multiple cellular enzymes and inhibits aerobic metabolism It is primarily absorbed through the skin, respiratory and GI tract. The classic symptoms of heavy metal exposure are GI irritation (watery diarrhea, vomiting and abdominal pain) with multisystem organ failure. Neuropathy can present…
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tca OVERDOSE DISCUSSION: Background: Tricyclic antidepressants (TCA) were introduced in the 1950s to treat depression, but are now more commonly used as migraine prophylaxis and in the treatment of fibromyalgia, neuropathic pain, and obsessive-compulsive disorder. The shift away from using TCAs for depression was in large part due to the drug’s narrow therapeutic index, which…
Read MoreContributor: Rachel Beham, PharmD Educational Pearls: Coricidin HBP Cough & Cold (dextromethorphan and chlorpheniramine) is one of the more commonly abused over-the-counter medications Dextromethorphan, binds to multiple receptors, particularly at high doses Opioid receptors, causing respiratory depression, CNS depression NMDA receptors, causing agitation and hallucinations Serotonin-reuptake inhibition, which may lead to serotonin syndrome, especially when…
Read MoreAuthor: Don Stader, MD Educational Pearls: Abstinence from substances such as tobacco or alcohol are effective strategies to achieve long term sobriety However, abstinence is not an effective strategy for achieving sobriety with opiate use disorder (OUD) Up to 90% of those who use an abstinence-only strategy for OUD will relapse within a month. Attending…
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