3/37
8/21/93 MAR IMSR (?) Admit
23 y(ear) o(ld) w(hite) male with h(istory)\o(f) Crohn's Disease (age
16-19) currently in remission, also with h(istory)\o(f) Panic attacks x (for)
2 years with signs of depression. Recently started on Elavil 2 weeks ago
with incremental doses (now on 60 mg qd-once a day). Patient has noted
some signs of orthostatic hypotension x (for) last 2 d(ays) with decreased
appetite, but has been otherwise well. Today was noted to have witnessed
LOC (loss of consciousness) persisting approximately 10 minutes post event
- no mention of fecal, urinary incontinence but patient with multiple
abrasions over face. Denies suicide attempt or excess ingestion med
(medications) Elavil 60 (mg) qd (once a day)
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P(hysical)/E(xam) B(lood)P(ressure) 160/80 P(ulse) 110
R(espirations) 16 tahb (?) neg orthostat (?)
HEENT (head, eyes, ears, nose, throat) PERLA (pupils equal reactive to light)
EOMI (?) neck supple oroh (?) clear
no nodes multiple facial abrasions
CVS S1S2 (?)
lungs cta (clear to auscultation)
abd(ominal)B(owel)S(ounds) normal soft NT (?) ND(?) -HSM(?)
ext(ernal) ? 2+pulse (?)
CNS (Central Nervous system) WNL (within normal limits)
AxOx3 (completely alert and oriented) pleasant white male nonfocal
no meningitis signs.
14
labs: 17.7>----------->253 S7 101>84
44.3 89 4.1 1.2
Calcium-Magnesium (P) 12.9/11.7
26/29
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Impression-------------likely seizure ingesting of new elavil
loading. Doubt excessive ingestion
No serious trauma
Slight widening of QRS but no other arrhythmia's
Will admit to telemetry. Patient given HCO3 (bicarbonate) +
dilantin load. Amitryptylline level sent.
L.S.
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