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The Shit That Killed A Rock Star. Bryan S Judge, MD IUSOM Medical Toxicology Fellowship ACMT CPC Competition September 5, 2003. Case Presentation. 25 year-old male Chief complaint: Dyspnea Diagnosed with Pneumocystis carinii pneumonia at another ED - PowerPoint PPT Presentation
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Bryan S Judge, MDIUSOM Medical Toxicology
FellowshipACMT CPC Competition
September 5, 2003
Case Presentation• 25 year-old male• Chief complaint: Dyspnea• Diagnosed with Pneumocystis
carinii pneumonia at another ED
• Patient transferred to a tertiary referral hospital
Past Medical History• Illicit drug abuse with several
prior admissions to drug rehabilitation centers
• Negative HIV antibody test within the last year
• Denies regular use of any prescription or OTC medications
• Has no known drug allergies
Social History• History of intravenous cocaine,
heroin and methamphetamine abuse
• Unemployed, lives with girlfriend• Smokes 1 pack of cigarettes/day• Denies use of ethanol• Occasional marijuana use
Case Presentation• Patient remained dyspneic
upon arrival to the tertiary referral hospital
• Patient denied use of cocaine, heroin, or methamphetamine for several days
Case Presentation• He admitted to taking 2
carisoprodol tablets within the last 24 hours
• Patient denied any cough, fever, chills, chest pain, recent weight loss, or sharing of needles
Case Presentation
• “Yeah, the shit that killed [rock star]. I knew it had to be a good trip if it killed [rock star]!”
Pertinent Physical Exam Findings
• Vitals: T- 98.3°F RR- 30/min P- 105/min BP- 112/72 mmHg O2 Sat- 82% on room air O2 Sat- 91% on 100% NRB
• General: Well nourished and in mild respiratory distress
Pertinent Physical Exam Findings
• Heart: Tachycardic without murmur or rub
• Lungs: Diffuse rales bilaterally• Extremities: Track marks in the left
antecubital fossa and multiple tattoos on chest and arms
• Remainder of exam is unremarkable
Complete Blood Count
15.815.8
45.045.0242400
15.915.9
60% Neutrophils26% Lymphocytes6% Monocytes
Chemistry Panel
138138 105105
4.64.6 2323 0.70.7
1212141141
Anion gap = 10
Other Studies• Calcium: 8.6 mg/dL• Arterial Blood Gas on Room
Air:– pH: 7.40– pCO2: 34 mmHg– pO2: 46 mmHg– HCO3-: 23 mEq/L
Other Studies• ECG:
– Sinus tachycardia– QRS – 88 msec– QTc – 390 msec– No ectopy and no ischemic changes
• Salicylate, APAP and Ethanol Levels:– All are nondetectable
Other Studies• Urine Drug Screen:
– Amphetamines – Negative– Cocaine – Negative– THC – Positive– Benzodiazepines – Negative– Barbiturates – Negative– Tricyclic Antidepressants –
Negative– Opiates – Negative
Making The Diagnosis• Further history provided by
the patient helped to elicit the etiology behind his clinical condition