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MS T is a 55 y.o female with PMHx breast cancer, CAD, hypothyroidism, chronic pain. Presented to the ED after intentional ingestion of “handfuls” of her medications at 14:00 due to severe pain. She reports pain is associated with recent diagnosis of breast cancer. Notably when asked in ED if she was attempting suicide, she reported she wanted to keep fighting against cancer. Her husband was contacted by ED staff, and he denies any knowledge of recent cancer diagnosis. Patient reports cancer diagnosis 15 years ago with treatment and new diagnosis a couple of weeks ago. In discussion with her husband, he does report they were told she has some “reactive lymph nodes” in her abdomen about 2 weeks ago.

1013 was signed in ED. There is concern that she overdosed on amlodipine. Also, concern that she may have taken high dose of SSRI. Her husband reports she may have taken too much levothyroxine. She was agitated in the ED complaining of pain. She received Ketamine without improvement. Received activated charcoal. She became hypotensive and was started on norepinephrine.

Upon evaluation she is on norepinephrine 30 mcg/min, adding vasopressin. She is very agitated and complains of severe abdominal pain. Fentanyl administered with improvement in symptoms. Abdomen is soft and bowel sounds present on exam. Lactate4.5>>3.3. Glucagon infusion ordered. Planning for initiation of high dose insulin therapy for calcium channel blocker toxicity, however her potassium level is low 2.7. Planning to replace potassium and initiate insulin when potassium greater than 3.5

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