A puzzling overdose

by rcentor on January 25, 2012

Patient admitted after apparent overdose. Patient does not respond to verbal stimuli or tactile stimulation. Patient has known schizophrenia.

Exam comatose, VS T 99, P 80, R 18, BP 130/80

Otherwise exam is unremarkable

Labs

143	103	22	82
3.9	23	1.0	9.6

WBC 7.9

Hgb 12.9/ Hct 37.1

Plt 194

NH₃ 28

4 hours later

Labs

147	107	16	135
4.0	22	0.8	10.3

ABG on room air

pH 7.45

pCO₂ 29

pO₂ 126

HCO₃ 20

NH₃ 98

Can you guess what the overdose included?

{ 5 comments… read them below or add one }

Alec January 25, 2012 at 7:39 pm: I'm thinking something with salicylates to explain the respiratory alkalosis and the metabolic acidosis. I don't know if that's involved with the elevated ammonia…
amidoc January 25, 2012 at 8:58 pm: Valproate??
Ncpulmfellow January 25, 2012 at 10:15 pm: Valproate
Cory January 25, 2012 at 11:15 pm: Valproic acid major possibility due to rapid ammonia elevation.
I would also point out that blood gas is a physical impossibility under standard conditions .
Med School Odyssey January 26, 2012 at 10:01 pm: Alcohol?

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