Toxicology Case Report

History

M/19Known history of ecstasy/ketamine abuse.Found staggering in a shopping plaza in a

September afternoon.Police was called.Became unconscious en route to hospital.

Physical findings

GCS 7/15 (E1V1M5)BP 108/58 Pulse 78/minRR 10/minSpO2 97% Room AirTympanic temp. 36.6 CHb 13.5 g/dlH’stix 5.5 mmol/l

Physical findings

Pupils equal, 2mm sluggish to lightNeck softHeart sounds dual. No murmurs.Chest was clear. Shallow breaths. Abdomen soft and non-tender.

BS normal. No mass felt.Spontaneous 4-limb movements noted.

Physical findings

Incidental finding of 2 packets of white powdery substance beneath the underwear.

Police summoned to collect the packets.

Physical findings

ABG taken.pH : 7.31pCO2 : 7.7PO2 : 67.6 (100% O2)HCO3 : 28Na/K : 146/4.3

Physical findings

ECG : Sinus rhythm 78/minCXR : unremarkable

Diagnosis ?Diagnosis ?

Ecstasy overdose?

For:Ataxia

Against: NOT hypertensiveNOT tachycardicNOT hyperthermicNOT mydiatricNOT agitated

Ketamine overdose?

For: respiratory

depression(severe cases)

Against:NOT hypertensiveNOT tachycardicNOT mydriatic

Tentative diagnosis :Tentative diagnosis :

Opioid overdose

Progress

IV Naloxone was given Unresponsive with GCS 7/15 despite 4.4mg

given in increments over 23 mins.Rectal examination unrevealing.

Progress

Trial of IV flumazenil 0.5mg given.Fully conscious 2 mins. afterwards

Progress

Conscious and well after admission to medical ward.

Part time mobile phone salesman.Claimed occasional use of ketamine and

ecstasy.Denied other drug use.Discharged the next day.

Benzodiazepine overdose