8/13/2018
1
Symposium By The Sea
Toxicology Case Unknowns
Richard D. Shih, MD
Professor of Emergency Medicine
Emergency Medicine Program Director
Schmidt College of Medicine
Florida Atlantic University
Financial Disclosures
• None
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Case Study: Toxicology Unknowns - Digitalis Overdose and Nurses as Serial Killers, Summaries of Toxicology
A case study of a 40-year-old female patient with advanced non-Hodgkin's lymphoma who experienced symptoms of sick sinus syndrome after taking multiple medications, including digoxin. The document also discusses the potential dangers of digitalis, a plant source used in some medications, and the risks of digitalis overdose. Additionally, the document explores the phenomenon of serial murder by healthcare professionals, citing several notable cases throughout history.
What you will learn
- What are some notable cases of serial murder by healthcare professionals?
- What is the role of digoxin in the patient's case?
- What are the symptoms of sick sinus syndrome?
- What are the risks of digitalis overdose?
- What is the phenomenon of serial murder by healthcare professionals?
Typology: Summaries
2021/2022
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Symposium By The Sea
Toxicology Case Unknowns
Richard D. Shih, MD
Professor of Emergency Medicine Emergency Medicine Program Director Schmidt College of Medicine Florida Atlantic University
Financial Disclosures
- None
Case:
- 40 yo female with advanced non Hodgkin's lymphoma presented with SOB
- Multiple meds: lasix, digoxin, diovan, acyclovir, dapsone, FeSO4, procrit, solumedrol, advair, protonix, zofran, folic acid, mylanta
- HD #2: cardiac monitor: 6 second pause
Case cont’d
- Cardiology consult: dx: sick sinus syndrome -Digoxin stopped
- Digoxin level: therapeutic
- HD #5: cardiac monitor: Bradycardia
Digitalis Cont’d
- Rx: »Atropine »Pacemaker »Digibind
- Digibind indications: »Malignant arrhythmias »K+ > 5 mEq/L »Dig level > 10 ng/cc
Case cont’d
- Korean herbal: Sanghwang tea (2 cups/day)
- Digoxin level: 9.
- Admission digoxin: normal
- Last dose taken by patient: 3 days ago
- 2nd^ mysterious digoxin case in past 3 months
Nurse: Angel of Mercy
- 1967: Kristen Heather Gilbert » US nurse, 4 pts, IV epi » Münchausen by proxy
- 1991: Beverley Gail Allitt » UK nurse: 4 ped pts, IV insulin » Münchausen by proxy
- 2004: Aino Nykopp-Koski » Finnish nurse, 5 pts, sedatives & opioids » Psychotic: no other motive
- 2017: Niels Högel » German nurse, 90 pts, cardiac meds » Bored, killed for the “thrill”
Serial Murder by Healthcare Professionals 2006 J Forensic Sci
- Study of prosecuted cases: 1970-
- 90 cases (45 for serial murder) » 24 indicated pending trial » 54 convicted: 2113 murders attributed to them
- Injection most common » Also suffocation, tampering with equipment
- Night and evening shifts
- Very old, very young, critically ill pts
- Few with criminal records » Many with false credentials