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Old 10-11-2012
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Arrow Gyrus Daily Questions; Toxicology #2

A 37-year-old Caucasian male presents to the emergency department complaining, "It hurts so bad all over.,. think I'm dying." Of greatest concern to him right now are severe, diffuse muscle aches that have been present for several hours. He says he was feeling fine until he developed abdominal cramps last night. The cramps were mild initially but then gradually worsened in intensity. He has had four loose stools since this morning_ There is no blood or mucus in the stool. He also complains of persistent nausea but denies vomiting. He denies fever and abdominal bloating or flatulence. Vital signs include temperature of 36.5C (97.8F), blood pressure of 1441102 mm Hg, pulse of 881min, and respirations of 16/min. Physical examination reveals a sweating, thin man in considerable distress. Clear nasal discharge is evident and his pupils are dilated. This patient's clinical presentation is most consistent with withdrawal from which of the following drugs?

A Cocaine
B. Heroin
C. Alcohol
D. Amphetamine
E. Nicotine
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B. Heroin.............
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B heroin
Butmim surprissed he is alive with that bp and heart rate
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Ill give you guys a quick clue to diagnose heroin withdrawal because lets be honest, when we study this there's a point in which we are like all screwed up because a lot of drugs and substances have similar features.

IF you have ever seen someone or have been sick from Influenza then thats what heroin withdrawal feels and looks like.
The myalgias, coryza and all that that people with influenza suffer these patients suffer as well
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Old 10-11-2012
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You all are correct
Anwer is b. Heroin


This patient is demonstrating signs and symptoms that are often seen following an abrupt withdrawal from prolonged heroin use The symptoms present within 24 hours and can be very severe and distressing but are not life threatening. The most common withdrawal symptoms experienced include muscle spasms, joint pain, nausea and vomiting, diarrhea, abdominal cramps, rhinorrhea, lacrimation, and sweating.
On examination, the pupils are dilated and the patient is irritable_ Autonomic instability in the form of hypertension is often evident. ,

(Choice A) Abrupt cessation of cocaine use can cause a rebound suppression of cocaine's stimulant effect. This causes patients to feel irritable, drowsy, fatigued, and hungry (as opposed to anorexic while intoxicated). Psychomotor agitation or retardation may be present_

(Choice C) Patients suffering from alcohol withdrawal develop signs and symptoms between 12 and 48 hours after the last drink_ During the acute stage they develop sweating, hyperreflexia, tremors, and seizures. This is followed by acute hallucinosis (auditory/visual) in the absence of autonomic symptoms. The final stage is that of delirium tremens, which usually occurs 2-4 days after the last drink. Patients suffering from delirium tremens present with altered sensorium, hallucinations, and autonomic instability (tachycardia, fever, sweating). Death can result if the condition is not properly treated.

..(Choice D) Amphetamine, like cocaine, is a stimulant and therefore presents with similar withdrawal symptoms (irritability, fatigue, increased appetite, psychomotor disturbance). Depression is also common.

Choice E) Nicotine withdrawal can produce symptoms of irritability, anxiety, depression, insomnia, restlessness. poor concentration, increased appetite, weight gain and bradycardia. Educational Objective: Suspect heroin withdrawal in patients with pupillary dilatation, rhirtorrhea, muscle and joint aches, abdominal cramping, nausea, and diarrhea. The symptoms are severe and out of proportion to physical findings.
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Heroin. Cold Turkey...
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