Case 311 -- A 14-year-old Female with Emesis and Cyanosis

Contributed by Deepak Mohan, MD, James Harrison MD and Mohamed A Virji, MD, PhD
Published on line in June 2002


The patient is a 14-year-old white female who was admitted through the emergency department for what a teacher interpreted as an "attempt to choke herself", and emesis. The patient complained of a headache and abdominal discomfort. She had reportedly ingested 15 dark maroon, round pills a few hours earlier. She denied taking any other pills. She admitted that her intention was to harm herself.

The patient had a urinary tract infection one-year back. She is currently on birth control pills for menstrual irregularity. There is a family history of bipolar disorder and depression. The patient has a history of depression and has been in counseling for two years. The patient has good grades at a school that she recently started attending. She lives with her mother and sibs. She denied sexual activity and also denies drug or alcohol use.


Vital signs: Temperature 37, pulse 73, respiratory rate 35, BP 110/74, pulse ox 96% on room air, weight 92 lbs (41.8 kg).

On physical exam, the patient was found to be a well-developed, alert and oriented, white female who was vomiting. Her skin was cool and dry, there were no abrasions, ecchymoses or petechiae. She was normocephalic, and did not have any sign of trauma The pupils were equal, round and reactive to light. Pharynx was normal. The chest had clear breath sounds bilaterally. The lungs were clear to auscultation and percussion, there was good air movement, without any rales, retractions, rhonchi, stridor, or wheezing. The cardiovascular system was normal with normal S1, S2, no rubs, murmurs or gallops. Her abdomen was soft, and without tenderness. There was no abdominal distention, guarding, organomegaly, or any localized tenderness. The peripheral vascular capillary refill was observed to be normal in the left and right hands. However, cyanosis was present centrally and peripherally.

The cranial nerves were II-XII intact. The motor system showed 5/5 strength for the major flexors / extensors. The deep tendon reflexes at knee and ankles were normal bilaterally. Biceps reflexes were normal bilaterally. The gait and posture showed that cerebellar function was grossly intact. She was alert; and responding appropriately to the environment. The memory was intact. The patient had normal cognition




Case IndexCME Case StudiesFeedbackHome