----- Original Message -----
From: "Dunn Matthew"
Subject: Re: Taxing case 1 second instalment/ coma case.
> > noise of her getting out of bed to clean
> > herself up at 5:30 as she has been doubly incontinent.
>
> Another pointer to anticholinergic effects
Sorry Matt, a small point I know, but isn't incontinence associated with
cholinergic effects, not anticholinergic effects?!
Adrian Fogarty
(or combined dietary and alcohol
> indiscretion; but still wouldn't alter my management. Absence of pyrexia
> does not exclude anticholinergic or sympathomimetic poisoning (or indeed
CNS
> infection of any type); but I still wouldn't treat specifically as long as
> haemodynamically OK.
>
> > She has a pulse around 90 and a blood pressure
> > of 117/60. This all seems to point away
> > from intracranial mischief, and there is a degree of
> > difficulty in my mind pinning all this down. Blood
> > tests, including glucose, are unhelpful.
> >
> > Is there anything significant now?
>
> As before. Treat anything anatomical. If nothing shows up on CT, then I'd
> still think of anticholinergic poisoning or acute hepatic encephalopathy.
As
> long as QT and QRS normal on ECG and haemodynamically OK, treatment
> supportive at this stage. Not sure about blood tests being unhelpful: H+,
> CO2, WBC, Na, PT, Ca etc would be useful even if normal.
>
> Matt Dunn
> Warwick
>
>
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