Stoned 2

A 31 year old man presents with sweating, dizziness and palpitations; these symptoms progressively worsened over 15 minutes, and were associated with a severe fear of being harmed by the persons around him.

He also complains of hearing voices since waking up. These have been continuously warning him about a fatal accident in his future, and demanding that he change his lifestyle. He also complains of a sensation as if worms were crawling under his skin.

He has experienced difficulty in sleeping for last few weeks. During this time period he also experienced rapid changes in mood, typically over a matter of minutes.

His medical and surgical histories are unremarkable. However, he complains of decreased libido for one month. There is no family history of psychiatric disorders.

He has a 10 year history of drug use, including alcohol, marijuana and LSD. He has also consumed cocaine for 2 years with intravenous abuse for 3 months.

His capillary blood glucose level is 110 mg/dL

Select Relevant Investigations
12 Lead ECG

Performed

The ECG reveals sinus tachycardia, with a rate of 120 bpm. The QT interval is prolonged to 450 ms. No other abnormalities are seen.
Serum Electrolytes

Performed

Na+: 140 mEq/L (135-145)
K+: 4.0 mEq/L (3.5-5.5)
Cl-: 102 mEq/L (97-105)
Ca++: 8.9 mg/dL (8.5-10.2)
Urine Drug Screen

Performed

Benzoylecgonine: 650 ng/mL (<300)
Not positive for any other drugs.
CT Brain

Performed

No abnormalities detected.

Select Relevant Management
Aspirin
Benzodiazepines
Quetiapine
IV Magnesium Sulfate