Hypotension and Bradycardia in the Poisoned Patient

Welcome to the Kings County/SUNY Downstate toxicology blog series. In our first case, we will discuss the differential diagnosis and management of the poisoned patient who presents with hypotension and bradycardia.

Case
A 23 year old female is brought in by EMS after an intentional overdose. She reports taking a “handful of pills” that she found in a friend’s house but does not know what pills they are and the container is unavailable. On exam, she is ill-appearing with the following vital signs: HR 38/min; BP 74/48 mmHg; RR 12/min; Temp: 98.3° F; fingerstick glucose is 230mg/dL; and oxygen saturation is 100% on room air. She is awake and alert, her skin and pupillary exams are normal, and an ECG shows sinus bradycardia with narrow QRS, normal QTc, and no abnormal ST-T morphology.

What poisonings cause hypotension and bradycardia? What are the top toxicological causes on your differential for this patient?

 
What non-toxicological causes must you consider in all patient with hypotension and bradycardia?

 
In the next few weeks, we will discuss in detail the presentation and management of the poisoning that are in our differential.

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Hypotension and Bradycardia in the Poisoned Patient
Post 1: Case and Differential Diagnosis
Post 2: Beta-Adrenergic Antagonists
Post 3: Calcium Channel Antagonists

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Nathan Reisman

Emergency Medicine at Kings County Hospital Center/SUNY Downstate Medical Center