Monday, May 6, 2013

Beautiful Lady

A "beautiful lady" is brought to your emergency department by police for "bizarre behavior." She's red hot with cutaneous vasodilation yet not sweating. Her pupils are nice and dilated. She's anxious, babbling, agitated, dysarthric, and confused. "Everyone looks so small," she says. "It's like a Jonathan Swift book." (Okay, she might not have said that). She is only oriented to person and displays signs of paranoia. She reaches out and grabs invisible objects from the air. Exam shows absent bowel sounds. An EKG shows mild sinus tachycardia, otherwise normal. Finger stick glucose is normal. Labs and blood cultures are pending. A Foley is placed and 500mL of urine comes out.

Challenge: The police mention that she was found with the plant shown above. What's your diagnosis?

Image shown under GNU Free Documentation License.


Anonymous said...

Anticholinergic toxidrome?

Craig Chen said...

yes - great job
Beautiful Lady

The plant shown is Atropa belladonna or the deadly nightshade; the syndrome described is anticholinergic toxicity.

Sources: UpToDate; Wikipedia.