| Disease | ACCIDENTAL INGESTION OF PODOPHYLLIN(IN TR.BENZOIN) BY A 20 YEAR OLD WHITE FEMALE WHO THOUGHT THAT IT WAS COUGH SYRUP.
EMESIS WAS INDUCED.INITAL EXAM SHOWED A TEMP.OF 1024(RECTAL),PULSE 120,BLOOD PRESSURE OF 90/60 DROPPED TO 80/0,WHICH RAPIDLY WENT TO 120/84 WITH I.V.FLUIDS PATIENT WAS LETHARGIC AND UNABLE TO ANSWER QUESTIONS AUDIBLY.CONJUNCTIVA EXTREMELY INJECTED.
FUNDOSCOPIC EXAM WAS NORMAL.NECK WAS SUPPLE.LUNGS WERE CLEAR.HEART RR WITH 1/6 SYSTOLIC MURMUR AT THE LSB. ABDOMEN SOFT. NEURO-ONLY RESPONSIVE TO DEEP PAIN,DTR'S ABSENT.
INTIAL LAB DATA:SPINAL FLUID HAD A CELL COUNT OF 0,PROTEIN 24MG%,GLUCOSE 88MG%,NEGATIVE GRAM STAIN.HGB 16.8,WBC 25.8,POLYS 79,BANDS 13,LYMPH 8. BLOOD GASES PK 7.40,PO2 78,PCO2 30,HCO3 18.
CATH UA SHOWED NEGATIVE ALBUMIN,GLUCOSE 4+,NEGATIVE KETONES,WBC 10-15,TRACE BACTERIA.
TREATMENT WAS WITH BROAD SPECTRUM ANTIBIOTICS AND IV STEROIDS TO RULE OUT SEPSIS. AFTER 24 HOURS SHE WAS STILL LETHARGIC,BUT WAS ABLE TO TALK. BY THE THIRD DAY SHE COULD SWALLOW LIQUIDS. BY THE FIFTH DAY SHE WAS ABLE TO FEED HERSELF.
EEG OBTAINED ON THE 4TH DAY SHOWED BILATERAL SLOWING PRIMARILY IN THE DELTA RANGE. THE HGB DROPPED TO 12.1 FROM 16.8 BY THE 4TH DAY AND THE STOOL WAS POSITIVE FOR OCCULT BLOOD.
A CINE ESOPHAGRAM WAS NEGATIVE. ENDOSCOPY REVEALED A HYPEREMIC ESOPHAGUS AND A SUPERFICIAL HEALING ULCERATION IN THE CENTRAL AREA OF THE STOMACH.
ON THE 2ND DAY SHE WAS NOTED TO BE HYPOCALCEMIC WITH A CA# OF 6.7%,WHICH WAS TREATED SUCCESSFULLY WITH I.V. CALCIUM CHLORIDE, BUT THIS HAD TO BE REPEATED.
THE PATIENT'S SENSORIUM RAPIDLY IMPROVED,BUT THE PERIPHERAL EFFECTS DID NOT. ON THE 6TH DAY THE NEURO-EXAM SHOWED THE PATIENT TO BE ALERT AND ORIENTED.
CRANIAL NERVES WERE INTACT. MOTOR EXAM REVEALED A FLACCID TETRAPARESIS INVOLVING BOTH UPPER AND LOWER EXTREMITIES: THE WEAKNESS WAS MUCH MORE PRONOUNCED DISTALLY.
BILATERAL WRIST DROP WAS PRESENT. ABILITY TO GRIP WAS ABSENT AS WAS THE PLANTAR REFLEX. SENSATION WAS INTACT OVER THE TRUNK,BUT THERE WAS DISTAL HYPALGIA IN ALL 4 EXTREMETIES.
PROPRIOCEPTION OF TOES AND FINGERS WAS ALSO ABSENT. PERIPHERAL INVOLVEMENT SLOWLY IMPROVED WHILE THE PATIENT WAS IN THE HOSPITAL AND SHE WAS CONTINUED ON A TAPERING DOSE OF STEROIDS.
PHYSICAL THERAPY WAS ALSO GIVEN. SHE HAD SEVERAL SYNCOPAL EPISODES SECONDARY TO POSTURAL HYPOTENSION. AT THE TIME OF DISCHARGE THE WRIST DROP HAD DISAPPEARED.
SHE HAD GAINED MOST OF HER STRENGTH BUT HAD TO USE A WALKER FOR AMBULATION. DTR'S WERE STILL ABSENT AS WAS PROPRIOCEPTION OF THE TOES AND FINGERS.
SHE CONTINUED THE PHYSICAL THERAPY AT HOME AND WAS TAPERED OFF THE PREDNISONE IN THE FOLLOWING TWO WEEKS.
FOLLOW-UP AT 3 MONTHS SHOWED THE PATIENT TO BE USING A SHORT LEG BRACE. MUCH IMPROVEMENT IN STRENGTH WAS NOTED, BUT SHE STILL HAD SOME DISTAL WEAKNESS.
DISTAL SENSORY LOSS AND AREFLEXIA WAS ALSO PRESENT. SHE CONTINUED TO HAVE ATTACKS OF POSTURAL HYPOTENSION.
FOLLOW-UP AT 10 MONTHS SHOWED VERY MUCH IMPROVEMENT. THE PATIENT WAS WALKING AT THIS TIME WITHOUT LEG BRACES. NEUROLOGICAL EXAMINATION SHOWED RESIDUAL WEAKNESS.
THE PATIENT WAS LOST TO FOLLOW-UP AFTER THAT. |