Clinical Vignette V

• Which of the following substances is most likely responsible for this patient’s signs and symptoms?

A 22-year-old male is evaluated in the emergency department for new onset of generalized tonic clonic seizure. The patient was brought in by his friend who states that they were having a good time at a Halloween party when the 22-year-old male suddenly started seizing for two or three minutes before it spontaneously stopped. According to the friend, the 22-year-old male has never had a seizure nor has he ever mentioned having a seizure disorder in the twelve years they have been close friends.

On physical examination, temperature is 101.2°F (38.4°C), pulse rate is 166 beats/min, blood pressure is 178/105 mm Hg, respiration rate is 26/min, and oxygen saturation is 95% breathing ambient air. The patient is diaphoretic and smells like alcohol and marijuana. His pupils are markedly dilated but reactive to light. He seems tremulous, agitated, and confused. The remainder of the examination is unremarkable.

• Which of the following options is considered an absolute contraindication for treatment of this 22-year-old male patient who experienced a seizure, markedly elevated blood pressure, severe tachycardia, hyperthermia, diaphoresis, tachypnea, dilated pupils, agitation and confusion after excessive use of a particular substance?