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- Oct 24, 2001
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Folks, caught a great case in the ER this weekend thought I'd share. Little old lady with no psychiatric history, living independently and not demented, brought in by family for visual hallucinations and no reality testing around delusion related to the visual hallucination x 24 hours. Started fluoroquinolone antibiotic for a UTI 24 hours before onset of symptoms, no prior treatment with this particular antibiotic and no family history of psychosis (reliable family). Mental status remarkable for good attention, concentration, A&O x3, no active VH but no reality testing around this delusion and continuing to insist it was true.
Initial ER attending documented, "likely fluoroquinolone-induced psychosis, consult psychiatry, change antibiotic to Keflex"
Next shift ER attending on when we actually got around to seeing the patient, "first break psychosis, head CT negative, admit to psychiatry."
After much arguing with ER attending, pt remained in medical ER overnight on keflex, and next morning patient states "I can't believe I was saying all those crazy things. Of course I didn't see ... (VH content). That is a very bad medication. Doctor, you need to put in my chart that I'm allergic to that medication."
My favorite line in the discharge paperwork, "Extremely low likelihood of first break psychosis given the VH and 36 hours of symptoms resolving without antipsychotics."
Makes you think twice about the possibility of mass anthrax prophylaxis.
MBK2003
Initial ER attending documented, "likely fluoroquinolone-induced psychosis, consult psychiatry, change antibiotic to Keflex"
Next shift ER attending on when we actually got around to seeing the patient, "first break psychosis, head CT negative, admit to psychiatry."
After much arguing with ER attending, pt remained in medical ER overnight on keflex, and next morning patient states "I can't believe I was saying all those crazy things. Of course I didn't see ... (VH content). That is a very bad medication. Doctor, you need to put in my chart that I'm allergic to that medication."
My favorite line in the discharge paperwork, "Extremely low likelihood of first break psychosis given the VH and 36 hours of symptoms resolving without antipsychotics."
Makes you think twice about the possibility of mass anthrax prophylaxis.
MBK2003