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8/23/93 (correct date is 8/24/93)  Medical Intern Transfer Note

     See Medical Intern Admission note of 8/21/93
       Briefly, this is a 23 year old male with panic attacks for 2 years who has
been treated by his father a psychiatrist with several medications most recently
Xanax and amitryptilene.  This patient noted symptoms of orthostatic
hypotension 2 days Prior to Admission and experienced a witnessed
syncopal episode with tonic clonic movements resulting in abrasions on face.
He was unconscious for several minutes but reached the ER Alert and
Oriented x 3.  In the ER he was found to be jittery with a mild tremor,
tachycardic to 110 and BP 160/80 non orthostatic.  He was afebrile. He was
treated presumptively, for Elavil toxicity with 1 ampule of HCO3 as his
QRS was .112.  He received 1 gm of Dilantin and was transferred in stable
condition without psychotic features to Telemetry.

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     Yesterday, the patient was noted to have the acute onset of visual
hallucinations. He was put on 1 to 1 PDA (?observation) and given
Ativan 2mg q(every) 4 hours.  Additional consultations with Dr. Speken
revealed that his son may have been taking Xanax in the past 2 weeks - 
a fact not disclosed on admission.  Over the past 18 hours the patient
has experienced a waxing & and waning delirium with visual & possibly
auditory hallucinations.  This morning he became more diaphoretic, his 
Heart Rate rose slightly to 120 and his BP has been 160/120.  He became
febrile to 100.5 degrees and the decision was made to transfer him to the 
ICU for closer monitoring and IV benzodiazepine treatment until Vital signs
stable

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