- Admit patients with suspected botulinum toxin poisoning to an ICU if the disease is evolving or respiratory compromise is suspected.
- Anticipate the need for inpatient rehabilitation to promote recovery.
Admit patients with suspected botulinum toxin poisoning to an ICU if the disease is evolving or respiratory compromise is suspected.
- On admission to the ICU:
- Seek pulmonary consultation in anticipation of intubation and ventilation support.
- Manage fluid and nutritional support.
- Contact the CDC and send them appropriate diagnostic tests.
- Administer antitoxin as soon as possible if diagnosis is likely.
- Be alert for complications of aspiration pneumonia and pulmonary embolus due to bedridden state.
- Be alert for paralytic ileus.
- In infants with infant botulism:
- Use antibiotics only for secondary bacterial infections, such as bacterial pneumonia; avoid aminoglycosides and clindamycin when possible, as these drugs may worsen the paralysis.
- Preemptively intubate when the protected airway is compromised; position the infant supine, with the head of the planar mattress (not the head of the infant) raised 30°.
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Anticipate the need for inpatient rehabilitation to promote recovery.
- Introduce a bowel or bladder program for patients who become incontinent.
- Plan for a comprehensive inpatient rehabilitation program after the patient is stable, which may include positioning, splinting, specialized beds, casting, and intensive range of motion.
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The American College of Physicians is accredited by the Accreditation Council for continuing Medical Education (ACCME) to provide continuing education for physicians. The American College of Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity. Purpose: This activity has been developed for internists to facilitate the highest quality professional work in clinical applications, teaching, consultation, or research. Upon completion of the CME activity, participants should be able to demonstrate an increase in the skills and knowledge required to maintain competence, strengthen their habits of critical inquiry and balanced judgement, and to contribute to better patient care. Disclosures: Larry E. Davis, MD, FACN, FACP received honorarium from Merck & Co., provided expert testimony, received grants from the VA, NIH, and the University of New Mexico, received royalties from Fundamentals of Neurologic Disease. Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
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