243.A 22-year-old woman presents to the ED by ambulance from a dance
club. The paramedics report that the patient was agitated in the club and had
a generalized seizure. Her BP is 165/100 mm Hg, HR is 119 beats per minute,
temperature is 100.9°F, RR is 17 breaths per minute, oxygen saturation is 98%
on room air, and fingerstick glucose is 92 mg/dL. On examination, the patient
is hyperactive and appears to be hallucinating. Her pupils are dilated to 6 mm
bilaterally and reactive. Her neck is supple. Examination of the heart is unre-
markable except for tachycardia. Her lungs are clear and abdomen is soft and
nontender. The patient moves all four extremities. Laboratory results are as
follows:
Sodium 109 mEq/L WBC 12,000/mm^3
Potassium 3.5 mEq/L Hct 49%
Chloride 83 mEq/L Platelets 350/μL
Bicarbonate 20 mEq/L
BUN 10 mg/dL
Creatinine 1 mg/dL
Glucose 103 mg/dLWhich of the following substances did this patient most likely consume?
a. Cocaine
b. Heroin
c. 3,4-Methylenedioxymethamphetamine (MDMA)
d. Ketamine (special K)
e. PCP
244.An asymptomatic young adult was brought to the ED by a police offi-
cer after his home was raided. The patient swallowed five small packets of an
unknown substance before being arrested. His BP is 125/75 mm Hg, HR is
85 beats per minute, temperature is 98.7°F, and RR is 16 breaths per minute.
Physical examination is unremarkable. An abdominal radiograph confirms
intraluminal small bowel densities. Which of the following is the most
appropriate treatment?
a. Magnesium citrate
b. Gastric lavage
c. Activated charcoal and polyethylene glycol
d. Syrup of ipecac
e. NAC
248 Emergency Medicine