Patient Presentation:
A 36 year old female, J.S., presents to the ED with her boyfriend. J.S.
started to feel ill 16 hours ago with nausea, vomiting and abdominal
cramping. Over the last 2 hours she has progressed to having double
vision, dry mouth and generalized weakness. In her history you find out
that she ate stink fish (fermented fish) yesterday with family members.
J.S. is AAAOx3. At triage in the ED her vitals were HR: 86, RR: 12, SaO2
92% on room air, BP: 113/68, Temp: 36.8. While in the ED J.S. experiences
increasing generalized weakness and a bilateral facial droop. J.S. is now
oriented times two and verbally responsive. After one hour in the ED her
vitals were as follows HR: 96, RR 8, SaO2 90% on a non-rebreather mask,
BP: 96/58.
Differential:
Diagnosis:
Labs: CBC & CMP: within normal limits
ABG at one hour: pH: 7.31, PaCO2: 52, PaO2: 81 HCO3 27,
Botulism Toxin sent out – it takes 48 hours to get results from the CDC.
EKG: normal sinus rhythm
Treatment:
2 IVs were initiated with 1 L bolus of NS administered, followed with a
rate of 125ml/hr. Due to the decrease in respiratory status J.S. was
intubated and placed on a ventilator in the ED. The Botulism Anti-Toxin
was administered due to the high index of suspicion. J.S. was transferred
to the ICU for monitoring and supportive care.
Outcome:
After 48 hours the CDC confirmed that it was Botulism. After nine days the
patient was weaned from the ventilator and resumed spontaneous
respirations.