Chief Complaint “Altered mental status and seizure”

Chief Complaint “Altered mental status and seizure” History of Present Illness SB is a 22-year-old male presenting to the emergency department unconscious. His roommate tells the admitting nurse that SB had consumed several full pots of “extremely strong coffee” in an effort to stay up to cram for his anatomy exam. The roommate called 911 after finding SB confused, breathing rapidly, and vomiting on the bathroom floor. Paramedics report that SB had several tonic-clonic seizures (Links to an external site.) (https://www.epilepsy.com/learn/types-seizures/tonic-clonic-seizures) in route to the emergency department. Medical, Family, and Social History SB’s medical and family history are unknown. His roommate tells the admitting nurse that SB does not smoke, drink alcohol, or use illicit drugs. SB currently attends a local community college and is planning to transfer to a four-year university after graduating. Image transcription text Medications Unknown Physical Exam SB is pale, , , and highly agitated. Physical examination reveals a of 11 (eye opening: 4; verbal response: 2; motor response: 5). His pupils are dilated. Muscle tenderness … Show more Laboratory Findings Laboratory studies demonstrated hyperglycemia, anion gap metabolic acidosis, hypokalemia, hypocalcemia, and hypophosphatemia. Elevated levels of lactate dehydrogenase, aspartate transaminase, alanine aminotransferase, and creatine kinase were noted. Complete blood count was normal. Blood alcohol level was zero and urine toxicology was negative. Tests for hepatitis A, B, C viruses and human immunodeficiency virus infection (HIV) were negative. Urinalysis showed a large amount of blood but very few red blood cells consistent with myoglobinuria. Plain chest X-ray was normal and an echocardiogram revealed a structurally normal heart. Initial electrocardiogram (ECG) showed tachycardia and non-specific ST-depression anteriorly and prolonged QTc interval without QRS widening. Image transcription text Comprehensive Metabolic Vital Normal Panel Sign Flag Values Glucose 285 Y 65-99 mg/dL Urea Nitrogen (BUN) 16 7-25 mg/dL PH 7.24 Y 7.35-7.45 Bicarbonate 16.7 Y 20-32 mmol/L Sodium 135-146 142 mmol/L … Show more Image transcription text Urinalysis, Complete Range Flag Normal Values Color Brown Y Yellow Appearance Clear Clear Specific gravity 1.026 1.001-1.035 PH 5.3 5.0-8.0 Glucose Positive Y Negative Bilirubin Negative Negative Keton… Show more Diagnosis Rhabdomyolysis caused by a massive (7.2 g) caffeine overdose. Management After consulting with nephrology and poison control, the healthcare professionals decided to give the patient activated charcoal via nasogastric tube and immediate hemodialysis. SB was started on potassium chloride and sodium bicarbonate IVs. Beta-blockade with esmolol was used to treat his tachycardia. Lorazepam was also administered. During his hospital stay, SB developed a toxic encephalopathy with left upper and lower extremity weakness that completely resolved as caffeine levels trended down. His serum caffeine improved to 33 micrograms/mL after a single hemodialysis treatment and his caffeine level was 8 micrograms/mL at 24 hours. The patient returned to baseline after only one dialysis treatment and he was discharged after four days in the hospital. Answer this questions: What is caffeine? What are the FDA guidelines for daily caffeine consumption? How does SB’s caffeine intake compare to these guidelines? What is a toxidrome? Briefly describe at least five of the most common toxidromes. Which type of toxidrome (Links to an external site.) (https://www.uptodate.com/contents/image/print?imageKey=EM%2F71268) matches SB’s symptoms? Explain your reasonin g based on his symptoms. What could be causing this condition in SB? How does caffeine affect the production and release epinephrine? Could an interaction between caffeine and the adrenal glands explain. SCIENCE HEALTH SCIENCE NURSING ANAT 102

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