History of Present Illness:
A patient in their mid-20’s is brought to the hospital with ALOC following a Maxalt and Lamictal OD.
Vital Signs & Physical Exam:
Vital signs are notable for tachycardia and elevated BP. She is altered but non-focal and a bit tremulous
Initial Diagnostic Testing:
- CBC: normal except for WBC 12
- Chem-7: normal except for Na 131
- Other: Beta HCG normal, tox screen normal
What is the most likely diagnosis?
- A) Stimulant OD
- B) Serotonin syndrome
- C) Alcohol withdrawal
- D) Seizure
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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QUIZ ANSWER:
- A) Stimulant OD – good thought but she is sleepy
- B) Serotonin syndrome – CORRECT – can be caused by triptans
- C) Alcohol withdrawal – good thought
- D) Seizure – serotonin syndrome can mimic seizure
1-Minute Consult on this topic: Click HERE and scroll to page 316.
CASE CONCLUSION: treated with benzos and admitted to ICU on 5150 hold. She did not require cyproheptadine. She got worse for about 12 hours then gradually improved and was discharged to a psychiatric facility.