Identifying the cause of intoxication case without a clear history using flowcharts: Identifying the cause of intoxication case without a clear history

Ardyan Wardhana

doi:10.59747/smjidisurabaya.v1i1.7

Authors

Ardyan Wardhana Faculty of Medicine, Universitas Surabaya, Mitra Keluarga Hospital, Surabaya, Indonesia

DOI:

https://doi.org/10.59747/smjidisurabaya.v1i1.7

Keywords:

medical care, intoxication, toxidrome, vital sign

Abstract

Background: Suspicion of intoxication and its causative agents are required in the clinical practice of intensive care units. Patients with loss of consciousness and no history of leading causation present obstacles in emergency room management. An understanding of toxidromes and epidemiological evidence can help clinicians. However, classic toxidromes are not always presented. Objectives: This case was presented to determine the flow of approaches to identify the cause of intoxication and to design early strategies for supportive care in intoxication case management. Case: A woman with loss of consciousness accompanied by seizures, deep and rapid breathing, and hypotension. Since the search for collateral information did not produce any meaningful findings, the toxin diagnosis was given based on vital signs, pupil size, and mental status. Methanol intoxication was suspected based on hypothermia, decreased consciousness, normal pupil size, and Kussmaul breathing. Forensic analysis showed her serum was positive for ethanol and methanol. Conclusion: When facing a case without the classic presentation of the toxidrome, the toxin diagnosis can be directed based on vital signs, pupil size, mental status, and muscle tone. Introduction to epidemiology is also important in tracking intoxication causation

References

Ambrosius, R.G.A., Vroegop, M.P., Jansman, F.G.A., Hoedemaekers, C.W., Aarnoutse, R.E., Van Der Wilt, G.J., Kramers, C., 2012. Acute intoxication patients presenting to an emergency department in the Netherlands: Admit or not? Prospective testing of two algorithms. Emerg. Med. J. 29(6):467–472. doi: 10.1136/emj.2010.106500.

Greene, S., 2019. General Management of Poisoned Patients. In: Tintinalli, J.E. (Ed.), Tintinalli’s Emergency Medicine:A Comprehensive Study Guide. pp. 1187–1194. Mc Graw Hill, New York, US,

Kerns, W., Tomaszewski, C., McMartin, K., Ford, M., Brent, J., Bogdan, G., Dart, R., Heard, K., Kokan, L., Kulig, K., Phillips, S., Wells, M., Akhtar, J., Ahsan, N., Burkhart, K., Donovan, J., Zimmerman, H., Curry, S., Wallace, K., Aaron, C., Burns, M., Graudins, C., Hartigan, S., Hantsch, C., Seger, D., Berlin, R., Douglas, D., White, S., Kirk, M., Hollander, J., McKay, C., Wax, P., 2002. Formate kinetics in methanol poisoning. J. Toxicol. - Clin. Toxicol. 40(2):137–143. doi: 10.1081/clt-120004401.

Mowry, J.B., Spyker, D.A., Brooks, D.E., Mcmillan, N., Schauben, J.L., 2015. 2014 annual report of the American association of poison control centers National Poison Data System (NPDS): 32nd Annual Report. Clin. Toxicol. 53(10):962–1147. doi: 10.3109/15563650.2015.1102927.

Pohjola-Sintonen, S., Kivistö, K.T., Vuori, E., Lapatto-Reiniluoto, O., Tiula, E., Neuvonen, P.J., 2000. Identification of drugs ingested in acute poisoning: Correlation of patient history with drug analyses. Ther. Drug Monit. 22(6):749–752. doi: 10.1097/00007691-200012000-00016.

Schabelman, E., Kuo, D., 2012. Glucose before thiamine for Wernicke encephalopathy: A literature review. J. Emerg. Med. 42, 488–494.

Sorge, M., Weidhase, L., Bernhard, M., Gries, A., Petros, S., 2015. Selbstvergiftung in der Akutmedizin – 2005–2012. Anaesthesist 64, 456–462.

Identifying the cause of intoxication case without a clear history using flowcharts