The American journal of emergency medicine
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A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and "very hot to touch" by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. ⋯ Laboratory studies revealed severe metabolic acidosis with acute renal failure and rhabdomyolysis. In spite of sedation, intubation, and aggressive cooling measures, the patient had cardiac arrest and died approximately 2 hours after arrival. Serum topiramate and valproate concentrations were within therapeutic ranges at 8.8 μg/mL (therapeutic 2-12) and 97 μg/mL (therapeutic 50-100), respectively.
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Crush injury from debris, combined with hypoxia and water and food deprivation (combined crush injury), is common in industrial accidents and events such as earthquakes and terrorist attacks. Whether electrocardiographic changes are associated with combined crush injury is unclear. ⋯ The findings suggest that abnormal electrocardiographic changes were seen in rats after simulated combined crush injury and decompression and were slow to resolve.
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Comment Letter
Myasthenia gravis and Guillain-Barré cooccurrence syndrome.