The patient is admitted to the hospital. Due to the fascinating findings, both neurology and internal medicine want to be the primary service. About 24-96 hours later, the patient develops neck flexion weakness, decreased deep tendon reflexes, cranial nerve abnormalities, proximal muscle weakness, and respiratory insufficiency. Now, neither internal medicine nor neurology wants the patient so he goes to ICU. After two weeks in the ICU including a stint on the mechanical ventilator, the patient has complete resolution of his neurologic symptoms.
Challenge: What's your diagnosis?
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SLUDGE syndrome due to exposure to organophosphate pesticide.
Organophosphate poisoning
organophosphate poisoning?
Well, obvious organophosphate poisoning with extended complications.
I'm guessing some of the complications are from extended exposure to the organophosphates, and possibly pre-existing respiratory problems.
I would be interested to see what the continued treatment was for this patient as well as what any abnormal lab values were.
-Brad
nice responses!
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Dehydrated
This is organophosphate poisoning causing severe cholinergic toxicity by inhibiting acetylcholinesterase. The acute manifestations and intermediate syndrome are described here. Treatment is with high doses of atropine, pralidoxime, benzodiazepines for seizures, and decontamination.
Sources: UpToDate; Wikipedia.
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