A 22-Year-Old Man Is Brought to the Emergency Department by Paramedics

question 142

Multiple Choice

A 22-year-old man is brought to the emergency department by paramedics after his mother found him lying on the bathroom floor.  Paramedics found him barely conscious with an empty bottle of bleach lying next to him.  His mother states that he drank the entire bottle.  He had mentioned to his mother that he wanted to end his life after his recent break-up with his girlfriend.  He is lethargic, but complains of severe pain and a burning sensation in his throat.
His other medical problems include major depression and post-traumatic stress disorder.  His sister also suffers from depression.  His medications include nortriptyline and fluoxetine, which he had not been taking for the past several days.  He has no known drug allergies.
His temperature is 37.2 C (99.0 F) , blood pressure is 90/60 mm Hg, pulse is 104/min, and respirations are 22/min.  Examination shows severe pharyngeal erythema/exudates, clear lungs, and normal first and second heart sounds.  His abdomen is soft and tender with decreased bowel sounds.  There is no rebound tenderness or rigidity.
Intravenous fluids were started.  Chest and abdominal x-rays showed no evidence of free air or pleural effusions and were essentially unremarkable.
Which of the following would be the most appropriate next step in management?

• A)Barium swallow
• B)Intravenous glucocorticoids
• C)Nasogastric lavage with cold saline
• D)Oral weak acid solution
• E)Upper GI endoscopy