The green man enigma: Unique presentation of toxicology in the emergency department
Abstract We describe a case report of hypertensive crisis induced by a combination of amphetamine and Marwitt's Kidney Pills. Diagnosis was delayed because of nonspecific physical findings including chest pain, abdominal pain, coughing, and diarrhea. This was confounded by puzzling physical exa...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12539 |
| _version_ | 1797835926810918912 |
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| author | Daniel Trotzky Gal Pachys Amir Zarror Jonathan Mosery Aya Cohen Khieralla Shaheen Eran Kalmanovich Eduard Ilgiyaev Galina Goltsman |
| author_facet | Daniel Trotzky Gal Pachys Amir Zarror Jonathan Mosery Aya Cohen Khieralla Shaheen Eran Kalmanovich Eduard Ilgiyaev Galina Goltsman |
| author_sort | Daniel Trotzky |
| collection | DOAJ |
| description | Abstract We describe a case report of hypertensive crisis induced by a combination of amphetamine and Marwitt's Kidney Pills. Diagnosis was delayed because of nonspecific physical findings including chest pain, abdominal pain, coughing, and diarrhea. This was confounded by puzzling physical examination findings, including green‐colored urine and fingernails. Diagnosis was aided with point‐of‐care ultrasound, which presented a picture of acute cardiac insufficiency, pulmonary congestion, and bilateral effusions. Laboratory values on admission indicated acute multiorgan injury. Detailed patient history revealed chronic consumption of “Kidney,” an over‐the‐counter drug available in Thailand with the primary ingredient methylene blue and used for a myriad of renal and genitourinary conditions. The patient also had a history of amphetamine use, which ultimately initiated his acute presentation. |
| first_indexed | 2024-04-09T15:00:24Z |
| format | Article |
| id | doaj.art-15b3d58ab6df47a682dd6f8c33ec0e18 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-09T15:00:24Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-15b3d58ab6df47a682dd6f8c33ec0e182023-05-01T17:35:54ZengWileyJournal of the American College of Emergency Physicians Open2688-11522021-10-0125n/an/a10.1002/emp2.12539The green man enigma: Unique presentation of toxicology in the emergency departmentDaniel Trotzky0Gal Pachys1Amir Zarror2Jonathan Mosery3Aya Cohen4Khieralla Shaheen5Eran Kalmanovich6Eduard Ilgiyaev7Galina Goltsman8Department of Emergency Medicine, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelDepartment of Emergency Medicine, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelShamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelShamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelDepartment of Emergency Medicine, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelDivision of Internal Medicine 'D', Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelCardiac Intensive Care Unit, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelDepartment of General Intensive Care, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelDivision of Internal Medicine 'D', Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated with the Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelAbstract We describe a case report of hypertensive crisis induced by a combination of amphetamine and Marwitt's Kidney Pills. Diagnosis was delayed because of nonspecific physical findings including chest pain, abdominal pain, coughing, and diarrhea. This was confounded by puzzling physical examination findings, including green‐colored urine and fingernails. Diagnosis was aided with point‐of‐care ultrasound, which presented a picture of acute cardiac insufficiency, pulmonary congestion, and bilateral effusions. Laboratory values on admission indicated acute multiorgan injury. Detailed patient history revealed chronic consumption of “Kidney,” an over‐the‐counter drug available in Thailand with the primary ingredient methylene blue and used for a myriad of renal and genitourinary conditions. The patient also had a history of amphetamine use, which ultimately initiated his acute presentation.https://doi.org/10.1002/emp2.12539amphetaminegreen fingernailsgreen urinehypertensive crisis“Kidney”–Marwitt's Kidney Pillsmethylene blue |
| spellingShingle | Daniel Trotzky Gal Pachys Amir Zarror Jonathan Mosery Aya Cohen Khieralla Shaheen Eran Kalmanovich Eduard Ilgiyaev Galina Goltsman The green man enigma: Unique presentation of toxicology in the emergency department Journal of the American College of Emergency Physicians Open amphetamine green fingernails green urine hypertensive crisis “Kidney”–Marwitt's Kidney Pills methylene blue |
| title | The green man enigma: Unique presentation of toxicology in the emergency department |
| title_full | The green man enigma: Unique presentation of toxicology in the emergency department |
| title_fullStr | The green man enigma: Unique presentation of toxicology in the emergency department |
| title_full_unstemmed | The green man enigma: Unique presentation of toxicology in the emergency department |
| title_short | The green man enigma: Unique presentation of toxicology in the emergency department |
| title_sort | green man enigma unique presentation of toxicology in the emergency department |
| topic | amphetamine green fingernails green urine hypertensive crisis “Kidney”–Marwitt's Kidney Pills methylene blue |
| url | https://doi.org/10.1002/emp2.12539 |
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