Hook

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Can you solve this case? You're the ICU doctor on call and see if you can solve this toxicology case. It's an 18-year-old female who presents essentially with some seizures that and she was found down on the couch. She's known to have a history of depression, bipolar disease, anxiety and she's on a few medications for this as well. And she's also had a previous suicide attempt. Now the mother comes in and tells us as we're trying to get history about what's what happened is that last night as she went through a breakup and was unfortunately feeling quite down. The moment her had a conversation and then the mom went to bed. And this morning when the mum wake woke up, she found her daughter on the couch passed out, foaming around the mouth and with multiple bottles uh found down beside the couch as well. Now these medications were actually her mum's medications, the tablets that were found. We asked the mum what medications were found. I'm gonna save this for later because this is where the case gets interesting. When I assess the patient in the emergency department, she is uh currently confused. She can speak a few sentences but she doesn't know where she is, she doesn't know what happened, she doesn't remember last night or this morning. And uh just as we're talking, she starts to have a generalized tonic-clonic seizure. She starts having rhythmic jerking movements of both of her limbs and her hands and her eyes roll back and she loses consciousness. I immediately tell the nurse to get some benzodiazepines. We give her some Ativan and this aborts the seizures. She subsequently admits to the ICU and we complete a full work up to uh to identify the cause of the seizures and identify which toxic agent she's ingested on the rest of the examination. Her cardiac exam is fine. Her lung exam, you hear some crackles to the bases bilaterally and the abdominal exam examination is fine. You don't see any other rashes or anything like that. On the blood work, you see a normal white count, no changes in hemoglobin or platelets. You do see a sodium of 140, potassium of 4.1. Now in Venus blood gas, you see a pH 7.50, CO2 level of 20 and a bicarb level of 15. And the rest of her examination also demonstrates a lactate level of 5.1. A chest X ray done shows uh bilateral pulmonary edema and an ECG demonstrates uh some QRS widening. Now my question to you is from all the clues provided, can you diagnose what's going on? Can you identify which medication the patient ingested and what is the next step for treatment for this patient?