Expiratory wheezes were heard, and the skin was cold and mottled. The level of consciousness varied from unresponsiveness to combativeness. The electrocardiogram showed sinus rhythm at a rate between 40 and 50 beats/min. Despite a total of 2 mg atropine, 1 mg glucagon, and 1,900 ml crystalloid, systolic blood pressure remained less than 80 mmHg. Two hours after admission, the patient collapsed while having a bowel movement. Electrocardiogram and oscillometric blood pressure monitoring were instituted, and for the next 90 min, a sinus rhythm at a rate of 60 beats/min and blood pressure between 110/70 mmHg and 120/80 mmHg were observed. Gastric lavage was instituted without recovery of tablet fragments. Routine toxicologic screening was negative. Laboratory data revealed sodium 141 mmol/L, potassium 4.9 mmol/L, chloride 104 mmol/L, HCO 318 mmol/L, blood urea nitrogen 12 mg/dL (4.28 mmol/l), creatinine 1.2 mg/dL (106 micro mol/L), glucose 116 mg/dL (6.44 mmol/l), and hemoglobin 160 g/l. An electrocardiogram showed sinus rhythm with a ventricular rate of 72 beats/min. Physical examination was otherwise unremarkable. Blood pressure was 130/80 mmHg, heart rate was 72 beats/min, respiratory rate was 24 breaths/min, and tympanic temperature was 36.6 degrees Celsius. On arrival, he was alert and cooperative. A 50-yr-old, 98-kg man with a history of depression, coronary artery disease, hypertension, and asthma was brought to the our institution's emergency department after having allegedly ingested 20 atenolol tablets (50 mg/tablet) 30 min earlier.
0 Comments
Leave a Reply. |