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1/8 Recently, I was called to bedside to evaluate new tachycardia + hypertension (SBP >180) + AMS in a patient with MS. We were initially concerned for hypertensive encephalopathy, except he had no prior hx htn and BPs on previous admissions were always normal.
2/8 We didnโt have an immediate framework for acute tachy + HTN but we went back to physiology when approaching this combination of vital sign change: ๐๐๐บ๐ฝ๐ฎ๐๐ต๐ฒ๐๐ถ๐ฐ ๐ต๐๐ฝ๐ฒ๐ฟ๐ฎ๐ฐ๐๐ถ๐๐ฎ๐๐ถ๐ผ๐ป. When do you see this?
3/8
๐ฃ๐ฎ๐ถ๐ป: most common cause in the hospital.
๐๐ฟ๐๐ด ๐๐ผ๐
๐ถ๐ฐ๐ถ๐๐: meth,cocaine, caffeine,stimulants, serotonin syndrome, anticholinergics
๐๐ฟ๐๐ด ๐๐ถ๐๐ต๐ฑ๐ฟ๐ฎ๐๐ฎ๐น: ETOH,benzos, opiates
๐๐ป๐ฑ๐ผ๐ฐ๐ฟ๐ถ๐ป๐ผ๐ฝ๐ฎ๐๐ต๐ถ๐ฒ๐: Pheo, thyrotoxicosis, hypercortisolism
๐ฃ๐ฎ๐ถ๐ป: most common cause in the hospital. ๐๐ฟ๐๐ด ๐๐ผ๐
๐ถ๐ฐ๐ถ๐๐: meth,cocaine, caffeine,stimulants, serotonin syndrome, anticholinergics๐๐ฟ๐๐ด ๐๐ถ๐๐ต๐ฑ๐ฟ๐ฎ๐๐ฎ๐น: ETOH,benzos, opiates๐๐ป๐ฑ๐ผ๐ฐ๐ฟ๐ถ๐ป๐ผ๐ฝ๐ฎ๐๐ต๐ถ๐ฒ๐: Pheo, thyrotoxicosis, hypercortisolism
4/8 Our patient wasnโt in pain, and had negative tox screen. He was behaving exactly like he had delirium tremens, but was neither on benzos nor ETOH. What can mimic this?
6/8 Barbituate withdrawal! Barbituates have largely been replaced by benzodiazepines in modern medical practice, but mechanistically, have similar GABAergic effects. Withdrawal from barbituates looks very similar to DTs!
7/8 This patient had his longstanding barbiturate held on admission. Within 36 hours, he went into withdrawal which can happen when barbituates are stopped abruptly. After resuming his barbituate, his vital signs and mentation normalized.
8/8 Takeaways:
1. When you donโt have a set approach, go back to the physiology! @DxRxEdu
2. Barbituate withdrawal can happen within 48 hours of abrupt cessation and look just like DTs.
3. Work w/ your pharmacist to ensure safe med tapers and reconciliation. #MedTwitter #MedEd
1. When you donโt have a set approach, go back to the physiology! @DxRxEdu
2. Barbituate withdrawal can happen within 48 hours of abrupt cessation and look just like DTs.
3. Work w/ your pharmacist to ensure safe med tapers and reconciliation. #MedTwitter #MedEd
