Poisoning and Overdose Answers 265(a)Cocaine use can cause agitation and seizures but should not cause
significant hyponatremia. (b)Heroin intoxication usually causes people to
be more sedate rather than agitated. It should not cause seizures or hypona-
tremia. (d and e)Ketamine and PCP can cause agitation and hallucinations;
however, significant hyponatremia is not usually present.
244.The answer is c.(Goldfrank et al, pp 1013-1014.)Patients being
arrested who swallow illegal drugs to conceal the evidence are referred to as
“body stuffers.” They commonly tend to ingest any and all the drugs they
possess, potentially resulting in a polypharmaceutic overdose. Body stuffers
are usually seen in the ED before symptoms have developed. Activated
charcoalshould be administered immediately and whole-bowel irrigation
may be indicated. Sometimes there is radiographic evidence of the swal-
lowed substances as seen in crack vials or staples on the packaging materials.
Whole-bowel irrigation uses a polyethylene glycol electrolyte solution
(eg, GoLYTELY),which is not absorbed and flushes drugs or chemicals
through the GI tract. This procedure seems to be most useful when radiopaque
tablets or chemicals, swallowed packets of street drugs, or sustained-released
drugs have been ingested.
(a)Magnesium citrate is a cathartic whose action begins 4 to 6 hours
after ingestion. It is contraindicated in patients with renal failure. (b)The
packets are observed in the small bowel, too distal for effective gastric
lavage.(d)Syrup of ipecac is also ineffective for the packets in the small
bowel.(e)NAC is the antidote for acetaminophen toxicity.
245.The answer is c.(Goldfrank et al, p 889.)Any patient taking a
monoamine oxidase inhibitor (MAOI) is at risk for developing the serotonin
syndromeif the individual congests a selective serotonin reuptake inhibitor
(SSRI) or another drug that raises CNS serotonin levels. Some medications
that can cause this interaction include indirect-acting and mixed-acting sym-
pathomimetics (eg, cocaine, amphetamine), antidepressants (eg, TCA, SSRI),
meperidine (eg, Demerol),and dextromethorphan, which is found in many
nonprescription antitussives. In contrast, morphine and its derivatives lack
serotonin-potentiating effects. Serotonin syndrome is characterized by altered
mental status, hyperthermia, neuromuscular dysfunction, and autonomic
dysfunction. Symptoms may also include shivering, trismus, akathisia, coma,
and seizures.
(a, b, d, and e)Ibuprofen, acetaminophen, oxycodone, and hydrocodone
are all safe to use in patients taking MAOIs.