Emergency medicine journal : EMJ
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Serotonin syndrome is an under-reported and under-recognised condition that occurs on administration of selective serotonin re-uptake inhibitors alone, or in combination with other medication known to increase levels of 5-hydroxytryptamine. This case report demonstrates signs and symptoms associated with their overdose and illustrates the importance of recognition of this syndrome to instigate appropriate treatment for the patient.
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Case Reports
Case of the month: "Oh! Drat!--A case of transcutaneous superwarfarin poisoning and its recurrent presentation".
Superwarfarin poisoning is considered a significant public health problem in the US. In 2004, there were 16,054 cases of poisoning; most were accidental ingestions of rat bait by children but 4576 patients required hospital treatment, 23 patients had major adverse outcomes and 1 patient died. Similar information is unavailable for the UK. ⋯ Upon discharge, he required daily vitamin K and INR monitoring for a further month. The original inpatient team had not identified the specific poison (chlorophacinone). They were unaware that superwarfarins are more potent and longer acting than warfarin, with toxic effects for weeks or even months, and that large doses of vitamin K are often required.
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Boerhaave's syndrome is a transmural rupture of the oesopahgus. It is a rarer, and less well described complication of forceful emesis. The more common complication being a non-transmural Mallory-Weiss tear. ⋯ Initial examination was normal. He was subsequently diagnosed with Boerhaave's syndrome. This case highlights the varied presentation of this potentially fatal condition.
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A 79-year-old woman was out in the garden having lunch on a hot summer's day. She developed stabbing chest pains more severe on her left side, associated with radiation down her left arm. Severity was 7 out of 10. There was no relief of pain with glyceryl trinitrate spray. Risk factors for ischaemic heart disease include hyperlipidaemia, being an ex-smoker 40 years ago, no history of diabetes or hypertension. There was a family history of her father having a myocardial infarction at the age of 54. ECG revealed widespread deep symmetrical T-wave inversion in the chest leads and lateral limb leads. ⋯ Treatment with aspirin, ACE inhibitor, beta blocker and a statin.