Toxicology Case Report

History §M/19 §Known 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/min §RR 10/min §SpO2 97% Room Air §Tympanic temp C §Hb 13.5 g/dl §H’stix 5.5 mmol/l

Physical findings §Pupils equal, 2mm sluggish to light §Neck soft §Heart 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 : 7.31 §pCO2 : 7.7 §PO2 : 67.6 (100% O2) §HCO3 : 28 §Na/K : 146/4.3

Physical findings §ECG : Sinus rhythm 78/min §CXR : unremarkable

Diagnosis ? Diagnosis ?

Ecstasy overdose? §For: §Ataxia §Against: §NOT hypertensive §NOT tachycardic §NOT hyperthermic §NOT mydiatric §NOT agitated

Ketamine overdose? §For: §respiratory depression(severe cases) §Against: §NOT hypertensive §NOT tachycardic §NOT mydriatic

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