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Old 07-10-2011
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Question Patient with blurry vision after farm feast!

A 36-yr-old male presents with nausea, vomiting after his visit from farm feast. He gets blurry vision on watching TV for . He also feel drowsy all the time and difficulty in eating. He complains later he could not comb his hair. BP is 110/70 and HR is 70. Past history is significant for diarrhea few hrs ago. Next step in management is?
1. Lumbar puncture
2. Serum Anti-AchR analysis
3. Atropine dosage
4. Nerve conduction studies
5. Gastric lavage
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Old 07-10-2011
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Give Atropine first, the patient most likely having organophosphate poisoning due to exposure to pesticides at the farm
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Old 07-10-2011
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3. Atropine dosage
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Old 07-11-2011
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Answer is 3 atropine dosage
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Old 07-12-2011
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3. Atropine dosage

farm visit history with insecticide poisoning with choleninestarase inhibitor poisioning (DUMBBELSS )
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Old 07-12-2011
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Quote:
Originally Posted by confident View Post
A 36-yr-old male presents with nausea, vomiting after his visit from farm feast. He gets blurry vision on watching TV for . He also feel drowsy all the time and difficulty in eating. He complains later he could not comb his hair. BP is 110/70 and HR is 70. Past history is significant for diarrhea few hrs ago. Next step in management is?
1. Lumbar puncture
2. Serum Anti-AchR analysis
3. Atropine dosage
4. Nerve conduction studies
5. Gastric lavage

Answer is 5.Gastric lavage... cranial nerve 3,4,6 are involved,dysphagia,dysarteria,descending paralysis,after farm feast(usually after canned food),diarrhea (but some time constipation),hypotention,bradycardia indicates Botulism toxin. Treatment should be removing left over content from GI by enema, gastric lavage or inducing vomiting..
supportive care and antitoxin administration.

1. Guillain barre syn...ascending paralysis seen with lower limbs first involved..h/o preceeding viral infection seen

2. Serum Anti-AchR analysis required in myasthenia gravis..diplopia is early sign...eye, pharyngeal,respiratory muscle are involved so constituional features are seen. Diurnal variation of fatigue features are seen. Fatigue recovers on rest.

3. Diarrhea, lacrimation, salivation, urinary incontinence, crackles and ronchi are seen, insecticide odour from patient, loss of conciousness, fasciculations, pinpoint pupil , proximal muscle weakness not responsive to treatment are hallmark.

4. Lambert-Eaton myasthenic syndrome....most of features from question cenario features plus xerostomia or altered taste in mouth, proximal joints of upper arm and leg are first involved( i,e shoulder and hip), Orthostatic hypotention, h/o small cell lung cancer, autoimmune disorder may be seen
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