Unintentional cetirizine overdose causing anticholinergic syndrome.

The incidence of anticholinergic syndrome due to second generation antihistamines is infrequently reported. Largely due to their decreased affinity for central nervous system (CNS) receptors, second generation antihistamines are rarely associated with anticholinergic symptoms, though toxicity is still possible particularly when taken in excess. We report a case of a six year old boy who presented with agitation, hallucinations, fixed and dilated pupils, tachycardia, and hyperthermia consistent with anticholinergic toxicity several hours after accidental overdose of a second generation antihistamine, cetirizine. Early identification of this rare phenomenon is important not only for appropriate emergency management but also for avoidance of potentially invasive and unnecessary tests which may further increase patient morbidity.

Traumatic Takotsubo Cardiomyopathy in a Patient with Extensive Coronary Artery Disease.

Takotsubo Cardiomyopathy (TCM) should be considered in the differential diagnosis for patients with cardiovascular symptoms not only following emotional trauma but also following motor vehicle accidents. A 45-year-old woman presented with chest pain following a motor vehicle accident. While she had an elevated troponin level and an extensive history of cardiac disease, her electrocardiogram was normal. Echocardiogram, however, demonstrated transiently reduced left ventricular systolic function with mid to apical hypokinesis consistent with TCM. We emphasize the use of a diagnostic score and point of care focused cardiac ultrasound (FOCUS) to expedite the recognition, evaluation, and treatment of suspected TCM in an Emergency Department setting.

Abdominal cocoon syndrome: an obstructive adhesiolytic metamorphosis.

Abdominal cocoon syndrome (ACS), also known as idiopathic sclerosing peritonitis and primary sclerosing peritonitis, is a rare condition causing small bowel obstruction first described in 1978 by Foo et al It is characterised by total or partial encasement of the small bowel in a fibrocollagenous cocoon-like sac accompanied by extensive intrinsic small bowel adhesions. While the aetiology of this condition remains largely unknown, ACS can be divided into two subtypes: primary or idiopathic, which is often accompanied by cryptorchidism, and secondary to another cause such as congenital dysplasia or medications. Definitive diagnosis can only be achieved following laparotomy with extensive lysis of adhesions to alleviate the obstruction. However, preoperative diagnosis is possible if clinicians are aware of the condition and its radiologic signs.

Peritoneal encapsulation: a rare cause of small bowel obstruction.

Peritoneal encapsulation syndrome (PES) is a rare cause of small bowel obstruction (SBO) in patients with no prior history of abdominal surgery. First described by Cleland in 1868, PES is a congenital condition characterised by small bowel encasement in an accessory, but otherwise normal peritoneal membrane. 1 2 A result of abnormal rotation of the midgut during early development, the condition causes fibrous encapsulation of the intestines, thus preventing bowel distention.3 While preoperative diagnosis is difficult, several case reports have described clinical and imaging signs that can help clinicians with not only recognising the condition but also preparing appropriately for perioperative discovery of anatomical variants. 3 4.