In anticipation of episode number 27 on drugs of abuse, we have with us Dr. Margaret Thompson,

one of Canada's leading toxicologists who's going to tell us her best case ever when it comes to drugs of abuse.

So having practiced emergency medicine and toxicology for quite a while now, It's difficult for me to say that there's a

best case ever. There's a couple of remarkable cases in my past that taught me some lessons. One of

them was a young man who had taken and actually used to use ecstasy every weekend, unbeknownst, of course, to his parents.

So it wasn't unusual for him to do that.

In this particular Friday night, on a midnight shift, presented to the emergency department

just after 3 a.m. myself and the resident who was working with me were made aware of his

presence in the emergency department

unfortunately a half hour, 45 minutes after he was in the emergency department. So he was brought

to the resuscitation area. The nurses worked him up and put lines into him and did a cardiogram

and talked to the family and we were were busy, and we're finally called

over to the resuscitation area, and this is a gentleman who certainly had serotonin syndrome,

which ecstasy has been known to cause. He was in Glasgow Comoscale of 4. He was tachycardi with a

heart rate of about 175. It was hypotensive

already with a pressure close to 80. And he's a big strapping kid, so I should have had a much higher

blood pressure than that. He was breathing rapidly. His sats were fine. He was diaphoretic as heck. He had persistent clonist just at rest so that all the extremities were doing sort of deserabate sort of movement spontaneously. His temperature was 42-something. He developed significant rhabdomyelysis. He had renal failure on presentations.

It was first electrolytes.

Suggested that he'd probably been down for quite a while.

We aggressively cooled him, despite that, developed DIC.

Started bleeding from every orifice that he had.

Eventually, he bled into his brain and died from conning.

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