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                                     TOXICOLOGY RONDE 2011.1.   Deadline March 24^st                Lab nr.:

CASE HISTORY: 
A 34-year-old emergency medical technician with a history of hypertension was admitted to the hospital for a wide complex tachycardia. She had a history of palpitations for which she had received an extensive cardiology workup and a sotolol prescription. Other medications included esomeprazole, sertraline and triamterene/hydrochlorotiazide. She was already scheduled for an implanted loop recorder to definitively exclude organic disease. She reacts agitated, tremulous and had nausea with episodes of emesis. She developed runs of stable ventricular tachycardia. She refused to answer questions, which might suggest Munchhausen syndrome. Labs: serum bicarbonate 15 mmol/L, anion gap of 25. Potassium 1.9 mmol/L.
We consider salicylate and theophylline intoxication, but we can’t fit sertraline in the picture.
Can you help us to clear this case?

CODE
1 = color reaction                          5 = HPLC-SP                         9 = SPECTR                      13 = …………
2 = DLC                                          6 = HPLC-RP                       10 = EMIT
3 = GC                                            7 = HPLC-STIP                    11 = TDx/Axsym                 
4 = GC/MS                                      8 = LC/MS(/MS)                   12 = AAS/AES

Interpretation:                            

 1.    Intoxication?
       □ yes
       □ no

2.    Patiënt should be:
       □   sent home
       □   stay for clinical observation on emergency department
       □   transferred to I.C.-department
       □   stay for clinical observation

3.    Interventions (more options possible):
       □   gastric lavage
       □   vomiting
       □   activated charcoal
       □   more times charcoal/laxative
       □   antidotes
       □   haemodialysis or other extracorporal elimination
       □   forced diuresis
       □   specific treatment: ……………………………(max. 2 options)

4.    Cave following complications (more options possible):
       □   convulsions
       □   liver failure
       □   kidney failure
       □   rhabdomyolysis
       □   extrapiramidal disorder
       □   QT-time prolongation
       □   other: ……………………………………………(max. 2 severe symptoms)

5.    Second drug assay needed?
       □   yes
       □   no

Supplementary advise about treatment (max. 20 words)

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