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 THE ACUTELY ALTERED TEEN

Morning

Erin Helm

Fmil! M

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H$%

1& !er ol" 'emle

(ro)g*t to ED +! *er 't*er

,)""en onset o' 'lling- #on')sion-

e.ent)ll! .omiting

A#ting normll! *en s*e got *ome 'roms#*ool

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MED%CAL AND ,0C%ALH%,T0RYDepression

,trte" #o)nseling lst mont*

$ro# 2 mg 3"!

 Tro"one 5 mg 3*s prn insomni

,el'in)r!

2 mont*s o' #)tting

Lst time 2 "!s go

,trong 'mil! *istor! o' mentl illness n" s)i#i"e

Li.es it* grn"prents *o *.e #)sto"! ,ees "" reg)lrl!

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E7AM 28 9AT$RE,ENTAT%0N: T &;2 HR 160. RR 25 ($ 112/52 ,02 EN8 Sleepy, wakes to voice. Slurred speech. Confused.Tangential.

EYE,8 $)pils & mm- re#ti.e ro!inent ocular clonus "ilateraE0M%

HENT8 ?NL

C@/$ULM8 T#*!#r"i#

A(D0MEN8 ?NL

NEUR08 #ine tre!or with activity. $or!al %& tone. 'ncreasetone. 6 "eats of induci"le ankle clonus "ilaterally. )* patell+TRs. ta-ic.

,%N8 rm n" B)s*e" C)ts #ross UEs

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D%FFERENT%AL D%A>N0,%,

?

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D%FFERENT%AL D%A>N0,%,

 Toi#%ngestions8 nti#*olinergi#- s!mpt*omimeti#- sli#!ltes- serotonins!n"

?it*"rl sttes8 (r+it)rtes- et*nol 9DTs:- se"ti.e*!pnoti#s

 En"o8 T*!roi" storm

 %D8 Tetn)s- meningitis- sepsis

 Ne)ro8 ,troe- t)mor

 Mis#8 Mlignnt *!pert*ermi- ne)rolepti# mlignnt s!n"

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?0R U$

 C(C8 Norml (M$8 Norml

 C8 Norml

 @(>8 ;&4/&&/65/1;2

 ,er)m to8 Negti.e Et0H- #etminop*en- sli#!lte

 Urine to8* C, * piate

 Urine pregnn#!8 Negti.e

 E>8Sinus tachycardia. Norml T#

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ADD%T%0NAL H$%

 >rn"p #lls it* more in'ormtion

 Re#ent s)i#i"l t*rets

 A"mits to n ingestion o' *n"')l o'

'rom lo#l gro#er! storeG $res#ription pills #o)nte"- ll ##o)nte"

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ADD%T%0NAL H$%

 Clle" $oison Control +# it* ""itionl in'orm

 Cons)lte" toi#olog!

 Lerne" t*t+&/TR&THRH$8 C)ses 'lse positi.e "r)g s#reens

 %s "isso#iti.e generl nest*eti# *ll)#it *ig* "oses

 %s *t i"s t*ese "!s re "oing 'or ')n

 ?*en mie" it* serotonergi# me"s- #n #

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,ER0T0N%N,YNDR0ME

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FEATURE, 0F ,ER0T0N%N,YNDR0ME

Cogniti.e/(e*.iorl Confusiondisorientation 54=

  Agittion/irrit+ilit! &5=

  Com 2K=

  Aniet! 16=

  H!pomni/sei)res/

*ll)#intions

15=

A)tonomi#

  H!pert*ermi 46=

 +iaphoresis 46=

  Sinus tachycardia 41=

  H!pertension &&=

  T#*!pne/m!"risis 2;=

Ne)rom)s#)lr yoclonus Hyperre3e-ia

 usclerigiditytre!or  H!per#ti.it!/

restlessness ta-ia

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HUNTER ,ER0T0N%N T07%C%TYCR%TER%A

%n ptients it* non ingestion o' serotonergi# gent 9one o''olloing:8

 ,pontneo)s #lon)s

 %n")#i+le #lon)s gittion or "ip*oresis

 cular clonus * agitation or diaphoresis Tre!or * hyperre3e-ia

 H!pertoni tempert)re 14F o#)lr or in")#i+le #l

,ensiti.it! K4= n" ,pe#i#it!

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MED%CAT%0N, THAT MAY C0NTR%(UTE T0 ,ER0T0N%N

,YNDR0MEAmp*etmines Anti"epressnts Antiemeti#s

E#sts! ()spirone Meto#loprmi"e

Detromp*etmine Lit*i)m 0n"nsetron

Met*mp*etmine M0A%s Antimigrine Dr)gs

,i+)trimine SSR's Cr+mepine

Anlgesi#s ,NR%s Ergot lloi"s

C!#lo+enprine Tra4odone  TriptnsFentn!l TCAs @lproi# #i"

Meperi"ine Mis#ellneo)s

 Trm"ol Co#ine

+e-tro!ethorphan

Lineoli"

,t Oo*nPs ?ort

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 TREATMENT

 ,top ll serotonergi# me"i#tions

 ,!mptom #ontrol

 H!pert*ermi8 eternl #ooling mes)res

 Agittion- m!o#lon)s8 +eno"iepines 9Lorepm 2 to 4 mg/g

#*il"ren:

 C!pro*ept"ine 9serotonin ntgonist:

 Monitor 'or r*+"om!ol!sis- D%C- met+oli# #i"osis

 Mortlit! rte 1115=

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E7AM 148 9AFTER AT%@A T &; HR EN8(ying in "ed 5uietly

 EYE,8 $)pils &mm- re#ti.e'nduci"le ocular clonus it* )pge n" lterl ge

 HENT8 ?NL

 C@/$ULM8 ?NL

 A(D8 ?NL

 NEUR08 Norml UE tone'ncreased (& tone. )7 "eats of induankle clonus "ilaterally. )* patellar +TRs.

 ,%N8ale.

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E7AM K8 9AFTERCY$R0HE$TAD%NE: T &;4 HR 12 ($ 11K/61 RR 2

 >en8 Ae- Alert- NAD

 E!es8 $)pils & mm- re#ti.ecular clonus present "ut decrefro! yesterday.

 HENT8 ?NL

 C@/$ULM8 ?NL

 A(D8 ?NL

 NEUR08 Norml UE tone Mil"l!increased (& tone. $o aclonus. 8* patellar +TRs.

 ,in8 ?NL

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FAL,E $0,%T%@E DRU>,CREEN

piates hencyclidine

Detromet*orp*n Detromet*orp*n

Dip*en*!"rmine Dip*en*!"rmine

Fl)oro3)inolones Detromp*etmine

$opp! see"s n" oil Do!lmine

Ri'mpin %+)pro'en

)inine %miprmine

etmine

Meperi"ine

 T*iori"ine

 Trm"ol

@enl'ine

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REFERENCE,

A+les- A et l $re.ention- Dignosis- n" Mngement o' ,eroto

,!n"rome Ameri#n Fmil! $*!si#in 21Q K1 9