- Joined
- Jan 6, 2003
- Messages
- 1,641
- Reaction score
- 14
Admitted a medicine pt who showed up with new R-sided weakness and slurred speech. What looked like CVA became complicated by what looks like withdrawal.
I'd appreciate suggestions from anyone who has seen pts like this:
- hyperreflexic, clonus superimposed on her R-sided weakness
- slightly elevated temp, no fevers, flushed, intolerant of heat, hypertensive, like serotonin syndrome
- elevated CK, otherwise completely normal chemistry and CBC, TSH nl
- CT head with 1 cm likely infarct in R basal ganglion, unclear etiology; no MRI 2/2 agitation
- extremely agitated, tolerating relatively high doses of ativan and haldol and versed - what would knock down a normal person does not even touch her
PMH:
- no signif PMH, remote h/o heavy EtOH
- no pain meds, clean urine drug screen
- long h/o mental illness w/ no diagnosis or treatment
- pt has been self-dx and self-medicating with effexor, lamictal, celexa and trazodone at whatever dose she feels necessary - her toolbox is full of literally hundreds of pills bought online
Any experience/suggestions would be helpful and educational.
thanks
I'd appreciate suggestions from anyone who has seen pts like this:
- hyperreflexic, clonus superimposed on her R-sided weakness
- slightly elevated temp, no fevers, flushed, intolerant of heat, hypertensive, like serotonin syndrome
- elevated CK, otherwise completely normal chemistry and CBC, TSH nl
- CT head with 1 cm likely infarct in R basal ganglion, unclear etiology; no MRI 2/2 agitation
- extremely agitated, tolerating relatively high doses of ativan and haldol and versed - what would knock down a normal person does not even touch her
PMH:
- no signif PMH, remote h/o heavy EtOH
- no pain meds, clean urine drug screen
- long h/o mental illness w/ no diagnosis or treatment
- pt has been self-dx and self-medicating with effexor, lamictal, celexa and trazodone at whatever dose she feels necessary - her toolbox is full of literally hundreds of pills bought online
Any experience/suggestions would be helpful and educational.
thanks