qqqqqqqqqqqqqq___________5 - zen786

[ArchivalUser]

33 year old man is ambulated to the ER unconscious. upon arrival, you start to obtain vitals, start IV, EKG, and have the nurse withdraw blood for labs. His girlfriend in the meanwhile rushes in saying he ingested multiple pills after we got into a huge fight. she describes the pill to you as a circular white tablet with the letter "L" on it. you immediately start the patient on naloxone and wait 5-10 mins and realize no improvements. afterwards you start the patient on flumazenil and the patient immediately seizures. which of the following is most likely cause of the patients symptoms?

a) ssri toxicity
b) aspirin toxicity
c) opiate withdrawl
d) TCA antidepressants
e) cocaine withdrawl

[ArchivalUser]

ddd?

[ArchivalUser]

thats correct redceo123


what would be the mechanism ?

[ArchivalUser]

I don' really know...I just ruled out.With the patient unconscious and has seizures. TCA od>>>CCCs i.e. convulsions coma and cardio toxicity. So guessed.

[ArchivalUser]

Please explain the answer. Thanks

[ArchivalUser]

okay no problem lets dissect the question:

33 year old man is ambulated to the ER unconscious. upon arrival, you start to obtain vitals, start IV, EKG, and have the nurse withdraw blood for labs. His girlfriend in the meanwhile rushes in saying he ingested multiple pills after we got into a huge fight. she describes the pill to you as a circular white tablet with the letter "L" on it. you immediately start the patient on naloxone and wait 5-10 mins and realize no improvements. afterwards you start the patient on flumazenil and the patient immediately seizures. which of the following is most likely cause of the patients symptoms?


33 yr old male:
took a white tablet with the letter "L" = this is lorazepam.....
he was started on naloxone and no help : hence the patient did not ingest opiate as this is the therapy for opiate overdose...
now the patient received flumazenil.... and suddenly he got seizures...

now lets check out options:
aspirin does it cause seizures? not really more like metabolic acidosis
SSRI mostly flushing
opiate: already ruled out
TCA tox: causes seizures ****
cocaine: sympathomimetic symptoms....


now the patient was unconscious meaning he was being protected from seizures as "LORAZEPAM" does... when you reversed lorazepams seizure protective effect by given flumenazil ... the TCA toxicity effect took place causing the seizures...

this question was given in a CK book but i find it important and thought its hy to share in step 1...
great way of eliminating other options.

[ArchivalUser]

thanks a lot for your time and explanation

[ArchivalUser]

redceo123

what is the treatment for this patient?

[ArchivalUser]

Sodium bicarbonate

[ArchivalUser]

great!