10-07-2006, 12:21 AM
A 40-year-old woman is brought to the emergency department by her daughter who states that she found her mother at home several hours ago, confused, lethargic, and unable to get up from her chair or speak. Her mother has a seizure disorder for which takes an antiseizure medication. She also has a history of alcohol abuse in the remote past. For the past several weeks, her mother has been complaining of difficulty sleeping and anxiety. The patient is stuporous and unresponsive to verbal stimuli. Her blood pressure is 100/60 mm Hg, heart rate is 50/min, and respiratory rate is 9/min. The pupils are pinpoint, and there is horizontal nystagmus. Asterixis is present.
Laboratory examinations reveal: white cell count 9,800/mm3, sodium 150 mEq/L, BUN 18 mg/dL, creatinine 0.9 mg/dL, glucose 50 mg/dL, calcium 5 mg/dL, ammonia 100 μg/dL, albumin 3.0 g/dL, AST 100 U/L, ALT 80 U/L. The urinalysis and lumbar puncture are normal. A CT scan of the brain shows cerebral edema. Arterial blood gas shows a pH of 7.20, a pCO2 of 46 mm Hg, and a pO2 of 79 mm Hg. Osmolar gap is zero. The toxicology screen is negative for benzodiazepines and opioids. What is the most likely substance that this patient overdosed on?
(A) Phenytoin
(B) Carbamazepine
© Valproic acid
(D) Ethanol
(E) Valium
Laboratory examinations reveal: white cell count 9,800/mm3, sodium 150 mEq/L, BUN 18 mg/dL, creatinine 0.9 mg/dL, glucose 50 mg/dL, calcium 5 mg/dL, ammonia 100 μg/dL, albumin 3.0 g/dL, AST 100 U/L, ALT 80 U/L. The urinalysis and lumbar puncture are normal. A CT scan of the brain shows cerebral edema. Arterial blood gas shows a pH of 7.20, a pCO2 of 46 mm Hg, and a pO2 of 79 mm Hg. Osmolar gap is zero. The toxicology screen is negative for benzodiazepines and opioids. What is the most likely substance that this patient overdosed on?
(A) Phenytoin
(B) Carbamazepine
© Valproic acid
(D) Ethanol
(E) Valium