Four Loko

[HERBIE1]

Did the patient present nausea or vomiting. I would expect some sort of gastric discomfort from the Flagyl and ETOH mix. Has she been puking a lot and was she possibly dehydrated? It seems that this drink is bad for the body, I would wonder what effect the metronidazole might have had in her overall condition.

Nausea-no vomiting or diarrhea per the boyfriend. Nausea w/ us. I have no idea why she was taking the Flagyl, but I honestly doubted it was relevant to her immediate problems.

[ERDoc]

Absinth is illegal in the US, though there is a movement to change this. From the description, it sounds like the response to the Narcan was coincidence. If she is drunk, sometimes just the stimulation from what you are doing is enough to get them awake again.

[HERBIE1]

Doc- I should find out the ETOH level tomorrow when I follow up on this patient. I am very curious to find out if there is more to this story, exactly why she was taking the Flagyl, and if we missed anything. Could she have chronic diarrhea and other GI issues which could make her dehydrated? Distinct possibility, but who knows?

[ERDoc]

Don't beat yourself too bad Herbie. A lot of times, even if you don't find out what is going on there is nothing to do but wait it out. Toxicology is fun but the treatment is often just supportive.

[Vorenus]

Doc- I should find out the ETOH level tomorrow when I follow up on this patient. I am very curious to find out if there is more to this story, exactly why she was taking the Flagyl, and if we missed anything. Could she have chronic diarrhea and other GI issues which could make her dehydrated? Distinct possibility, but who knows?

I guess there are a lot of possibilities for chronic illnesses that could affect your ability to cope and deal with such a consume of alcohol.

@ERDoc: Is there a particular reason for Absinth to be banned in the US (well got to be ) - does it maybe has to do something with the Thujon issue?

[HERBIE1]

Absinth is illegal in the US, though there is a movement to change this. From the description, it sounds like the response to the Narcan was coincidence. If she is drunk, sometimes just the stimulation from what you are doing is enough to get them awake again.

One of our initial thoughts was this was a potential suicide gesture, but we found no evidence of that. As for the stimulation- she had zero response to the airway or the IV stick. After reading up about absinthe, this stuff is wild. There is even an entire society devoted to getting it legalized here. I realize the levels of the "psychoactive" drug vary greatly among the various preparations of the drink, so I imagine it would need to be strictly regulated.

I honestly think these drinks may actually contain wormwood since it's a common herb used for all types of holistic treatments and I don't think it's regulated. Since there are no ingredients listed on either the original can or the modified version, there is no way to know what they actually contain. Based on this patient's presentation, it HAS to be more than just ETOH.

[ERDoc]

After doing a quick Google search, I stand corrected. It was banned here in the US but apparently now is legal but not really being manufactured, propbably because of the more conservative climate here than elsewhere.

http://en.wikipedia.org/wiki/Absinthe

[HERBIE1]

Don't beat yourself too bad Herbie. A lot of times, even if you don't find out what is going on there is nothing to do but wait it out. Toxicology is fun but the treatment is often just supportive.

Kinda like the Exctasy and Special K overdoses in recent years. These people would suddenly become apneic, run extremely high fevers, and all the hospitals could do was supportive- ventilator, let the drug metabolize, and hope there wasn't brain damage. I recall seeing local ER's on the weekends with at least 3-4 patients on vents. Scary stuff.

[uglyEMT]

I can't say why, beyond my pay grade, but all the medics I have worked with pushed the Narcan once they heard Four was on-board and it seemed (at least to me) to have the same effect. A few minutes after the push response came up, then the agitation, then the vomiting.

I never realized Narcan or its dirivatives were strickly opiode reversers. I have seen it used so much from drunks to crack ods I thought it was the cure all sober in 5 minute med.

Time to read up.

[Vorenus]

One of our initial thoughts was this was a potential suicide gesture, but we found no evidence of that. As for the stimulation- she had zero response to the airway or the IV stick. After reading up about absinthe, this stuff is wild. There is even an entire society devoted to getting it legalized here. I realize the levels of the "psychoactive" drug vary greatly among the various preparations of the drink, so I imagine it would need to be strictly regulated.

Honestly, it`s not such a big deal, it`s just liquor with a very high percentage of ETOH (around 70, depending on the brand). Since the Thujone content is governed, it isn`t more hallucinatory than any other ETOH.

We sometimes drank that stuff, there are different "absinthe rituals" to consume it (mostly it`s 2 parts water, 1 part absinthe, then put some sugar in it and lit it to fire). You just have to be careful not to drink too much, out of obvious reasons.

I honestly think these drinks may actually contain wormwood since it's a common herb used for all types of holistic treatments and I don't think it's regulated. Since there are no ingredients listed on either the original can or the modified version, there is no way to know what they actually contain. Based on this patient's presentation, it HAS to be more than just ETOH.

I`m not sure how the wormwood is manufactured in absinth, but I guess simply adding it to a drink won`t set free the thujone (or does it, can`t imagine it that way, gotta research that).

Can`t really see why it couldn`t have been only ETOH. Sounds like she just got herself into the excitation stage - I`ve seen patients present themselves like this after (only) consuming alcohol.