fireflymedic Posted August 29, 2008 Author Posted August 29, 2008 Okay, first let me clear up - not paraplegia weakness to lower extremities - pt can stand but not for long periods of time with extreme weakness. Typed without thinking and for lack of better phrase. Weakness was due to spinal issues and resulting urinary retention thus the foley cath. Didn't give complete info and for that I'm sorry. Now that is clarified.... Temp : 101.4 Monitor : sinus tach at 122 occasional PVC's Glucose : 115 Meds : appear to be appropriately taken Zoloft started three days ago, Glucophage started one month ago Urine : straw colored, normal output, no unusual odors Respirations : 12 and shallow Lungs : clear in all fields No history of thyroid or other medical issues other than spinal problems and urinary retention. Pt has vomited five times in last 2 hours small amounts of liquid. Last oral intake previous evening at 6 pm it is now 10 am. No flank, back (outside of normal daily pain pt experiences), or abdominal pain. Denies any alcohol or illicit drug use. Family informs you he occasionally takes Ultram for the back pain and they believe he took one earlier this morning with his other meds. Now give it a try
ambulancetramp Posted August 29, 2008 Posted August 29, 2008 After looking into zoloft a little more this sounds like some of what is going on could be side effects to it. It can cause aggitation and confusion. I think there is also something else going on here. I think he may have some gi virus or... I would want to transport in a position of comfort. Give O2 start a line and give some fluid to try to bring up the bp some and see if it did any thing about the pvc's. Take him where he wants to go and see what develops enroute.
firedoc5 Posted August 29, 2008 Posted August 29, 2008 If he just started on the Zoloft, could be side effects that will subside over time when his system get's use to it. Still, sounds like he has some kind of infection. Even though he has the foley, is there any pain or burning of urinary tract? If vomited small amounts, was it more like dry heaves or just brief episode? Is there a reason for lack of food and fluid intake? Like just not hungry or thirsty, or feeling too sick. Does the skin appear to be dehydrated, or did I miss that in earlier posts? O2, IV NS, give fluid challenge.
medic429 Posted August 29, 2008 Posted August 29, 2008 I don't think mixing Zoloft and Ultram is a good idea.
firedoc5 Posted August 29, 2008 Posted August 29, 2008 BTW: Just because someone is on Zoloft doesn't mean they're crazy. :tongue3:
fireflymedic Posted August 30, 2008 Author Posted August 30, 2008 Medic 429 - you're onto something there....why don't you want to mix them? What can result? To the others - you're on the right track with the zoloft, but not quite there yet - there is NO infection in his system Firedoc - not stating he was crazy - family was making that complaint as he was a frequent complainer for mild problems, they thought this was no big deal initially
firedoc5 Posted August 30, 2008 Posted August 30, 2008 Medic 429 - you're onto something there....why don't you want to mix them? What can result? To the others - you're on the right track with the zoloft, but not quite there yet - there is NO infection in his system Firedoc - not stating he was crazy - family was making that complaint as he was a frequent complainer for mild problems, they thought this was no big deal initially I was more or less trying to make a funny. I'm on Zoloft too. No infection, but is febrile? Is that his normal temp? Hypersensitive to certain medications including the Ultram? Did he double up on the Ultram or other meds?
medic429 Posted August 30, 2008 Posted August 30, 2008 Would it have anything to do with seratonin syndrome? Just reaching here, don't know much about it though. A doc was telling me about it in the ER recently with what appeared to be an OD patient....will have to do some research.
fireflymedic Posted August 30, 2008 Author Posted August 30, 2008 Ding, ding, ding good catch Medic 429- seratonin syndrome it is. Common in SSRI (selective seratonin uptake reinhibitors such as zoloft) within first few weeks of treatment or in possible cases of overdoses. Can also be caused at any time if combined with medications that are MAOI's, TCA's or those such as ultram, effexor, zofran, fentanyl. Can cause a variety of symptoms which may include tachycardia, vomiting, nausea, uncoordination, fever, heavy sweating, confusion, agitation, and in later stages, seizures and coma. For more info check out here - http://www.mayoclinic.com/health/serotonin-syndrome/DS00860
Recommended Posts