A few choice Phillipus Aureolus Theophrastus Bombastus Von Hohenheim (#Paracelsus) quotes:
“Every little hair on my neck knows more than you and all your scribes”
“My shoe buckles are more learned than Galen and Avicenna”
“My beard has more experience than your high colleges”
Also, in addition to physick, he dabbled in alchemy and astronomy. E.g., concepts like bufonis arcanum – the secret of the toad (he believed that they could be used to treat plague). He wrote entire books on alchemy (albeit some posthumous ones were probably written by others).
He treated poisons with tartar emetic – AKA antimony potassium tartrate.
Notably, he was kicked out of his one academic position at Basel for burning students' copies of Galen’s and Avicenna’s classic medical texts in a bonfire.
All that aside - amazing person and a pioneer in his field. Why? Because he dared to buck tradition and say things like:
"Every cathartic is a poison if it is not administered in the proper dose."
And, of course, “What is that that is not poison? All things are poison and nothing (is) without poison. Solely the dose determines that a thing is not a poison.”
Amazing concept - against the prevailing dogma of the day, and led to no small amount of ridicule.
Although propofol can also turn urine green, we gave this patient methylene blue for vasoplegia / refractory shock. Read on for some CCB poisoning discussion. 1/
Severe calcium channel blocker poisoning is a difficult clinical challenge. These patients are profoundly hypotensive and generally receive the kitchen sink re: therapies. @toxiferoustales breaks down the mechanism: emcrit.org/toxhound/sneak…
2/
For a superb review of thw two most established effective therapies - vasopressors vs high-dose insulin - look no further than @mbspyres and @jonbcole2 friendly debate: emcrit.org/toxhound/hdi-v…
3/
@J_Corky@MNpoisoncenter@Eastmanov1@jonbcole2 Perfect timing to ask. See below: our PC was called with this case at the same time I was on renal service and our fellow was asked to see them. 50-odd yo woman presents with fatigue and these labs.
@J_Corky@MNpoisoncenter@Eastmanov1@jonbcole2 This is all uremia here (Ketones neg, sal neg)
I have personally not found a reference which correlates anion gap to degree of uremia - probably because degree of uremia is:
2/
@J_Corky@MNpoisoncenter@Eastmanov1@jonbcole2 a) Poorly coorelated with azotemia (BUN)
b) Poorly correlated with degree of symptoms and manifestations: you can "get used to" uremia (just like patients with chronic hyperK can have no EKG manifestations, but an acute rise from 4 -> 6 mEq/L might widen QRS) 3/
Thanks #medtwitter#meded#nephpearls for answering this question! As suggested by the wisdom of the crowd, the correct answer is cyanide poisoning due to "vitamin B17." (Shout-out to @J_Corky who guessed early on). See tweetorial for discussion!
@J_Corky Wait, they didn't cover that in training? Vitamin B17 is not a vitamin - it's marketed as one, though, and used as alternative therapy for cancer and "general health." Some alternative rx is innocuous - vitamin B17 is not.
@J_Corky Let's call vitamin B17 what it is - amygdalin. Amygdalin is a compound found in Prunus species seeds - peach pits, apricot seeds, bitter almonds. See that -CN (cyano) moiety at the bottom of the structure? That's right - it is hydrolyzed by gastric acid to cyanide. 2/