A 60 year old male with a past medical history of diabetes and tobacco use presented with epigastric pain, nausea, and vomiting. The patient was noted to have a significantly elevated blood glucose and an elevated potassium on a point-of-care chemistry at triage. The patient was immediately brought to the resuscitation team and an EKG (Figure 1) was performed:

The patient is a 51-year-old with a past medical history of hypertension, ESRD on HD who presented from HD today because he was unable to get his session secondary to hypotension. The patient states he has had low blood pressure and heart rate in the past. He takes multiple medications including clonidine patches, nifedipine and carvedilol.

You’re working a red team overnight and a patient with opioid use disorder presents after a fall. He’s concerned about MSK pain and reports his last opioid use was this morning. You order some plain films and analgesia, and move to the next room. An hour later, you go back to discuss the imaging results and you barely recognize him.

He’s diaphoretic, tachycardic, and vomiting. You give him fluids, methadone, and zofran, but despite these treatments there’s no improvement. It looks like opioid withdrawal . . . but are you missing something? Is there more we can offer to help this patient? Let’s talk about it on this week’s Pharm & Cheese.