Contributed by Hazim Najjar, M.D.
Published on line in May 2001
CLINICAL HISTORY:
A 15 year-old girl with unremarkable past medical history found unresponsive near her bed, 5min later she had an attack of tonic/clonic convulsion which lasted one minute with bluish discoloration of lips but no loss of sphincter control. Neither empty bottles nor pills found near her. She was rushed to the Hospital were she was admitted to PICU. Physical Examination was unremarkable apart from deep coma and gross hematuria. CT scan of the head was normal, EEG showed: Alfa wave coma c/w drug intoxication and Echocardiogram showed left ventricular dysfunction and multiple valve leakage.
LABORATORY FINDINGS:
TEST | 2-2 | 2-3 | 2-4 | 2-5 | RR |
Hb | 11 | 9.8 | 12-16 g/dl | ||
Platelets | 186 | 67 | 156-369 X10E+09/L | ||
Na | 148 | 144 | 135-145 mEq/L | ||
Ca | 7.3 | 10 | 12 | 11 | 8.5-10.5 mg/dl |
Ion Ca | 0.83 | 1-1.4 mm/L | |||
BUN | 58 | 71 | 34 | 5-20mEq/dl | |
Creat. | 3.6 | 4.1 | 3.2 | 2.4 | 0.5-1.4 mg/dl |
Glucose | 76 | 125 | 70-110mg/dl | ||
Osmolality | 315 | 275-299 mOsm/kg | |||
gGT | 88 | 95 | 109 | 40 | <40IU/L |
AST | 140 | 202 | 270 | 140 | <40IU/L |
ALT | 126 | 155 | 129 | 72 | <40IU/L |
T.Bili. | 1.3 | 2.5 | 3.3 | 0.3-1.5 mg/dl | |
Cong. Bili. | 2.2 | 3.2 | 0.0-0.3 mg/dl |
TEST | 2-2 | RR |
pH | 7.49 | 7.35-7.45 |
pO2 | 106 | 80-100 mmHg |
pCO2 | 21 | 35-45 mmHg |
HCO3 | 16 | 22-26 mEq/L |
CSF | Normal | |
CSF Culture | No growth | |
Blood Culture | No Growth | |
Urinalysis | RBC 193 / hpf | |
Urine Tox. Screen | Positive | |
Urine and Serum Comprehensive Tox. Test | -PHENYLBUTAZONE -KEBUZONE -CHLOROXYLENOL -Diphenhydramine -Nicotine Metabolite -Aniline |
Peripheral blood smear:
Done to evaluate for Anemia and Thrombocytopenia to role out aplastic anemia and showed: