Poisoning and Overdose 245236.A 51-year-old man presents to the ED complaining of nausea and
abdominal pain after drinking some “bitter stuff.” He is considered one of the
“regulars” who is usually at triage with ethanol intoxication. His temperature
is 97.9°F, BP is 130/65 mm Hg, HR is 90 beats per minute, RR is 16 breaths
per minute, and oxygen saturation is 97% on room air. Physical examination
is unremarkable, except for slurred speech and the smell of acetone on the
patient’s breath. Laboratory results reveal serum sodium 138 mEq/L,
potassium3.5 mEq/L, chloride 105 mEq/L, bicarbonate 23 mEq/L, BUN
10 mg/dL, creatinine 1.7 mg/dL, glucose 85 mg/dL, arterial blood pH 7.37,
and lactate 1.4 mEq/L. Urinalysis shows moderate ketones. Which of the
following is the most likely diagnosis?
a. Diabetic ketoacidosis (DKA)
b. Ethanol intoxication
c. Methanol intoxication
d. Isopropyl alcohol intoxication
e. Ethylene glycol intoxication
237.A 55-year-old man presents to the ED 6 hours after ingesting two bot-
tles of his baby aspirin. He complains of nausea, vomiting, dizziness, and
tinnitus. His temperature is 100.3°F, BP is 140/80 mm Hg, HR is 105 beats
per minute, RR is 31 breaths per minute, and oxygen saturation is 99% on
room air. Arterial blood gas on room air reveals a pH of 7.52, PCO 2 10 mm Hg,
and PO 2 129 mm Hg. The blood salicylate level returns at 45 mg/dL. Which
of the following is the most appropriate next step in management?
a. Administer activated charcoal, begin IV hydration, and administer sodium
bicarbonate.
b. Administer activated charcoal, begin IV hydration, and intubate the patient for
respiratory failure.
c. Administer activated charcoal, begin IV hydration, and administer NAC.
d. Arrange for immediate hemodialysis.
e. Observe the patient overnight to allow the body to metabolize the salicylates.