A 28-year-old woman
meduploader - 05-06-09 10:41

A 28-year-old woman comes to the emergency department 6 hours after the onset of insomnia, flank discomfort, and constipation that she attributes to a kidney stone. She is a resident of another state and is here visiting relatives. She takes oxycodone (six to eight tablets daily) for chronic low back pain, sumatriptan for migraines, and amitriptyline (25 mg at bedtime) and paroxetine (30 mg daily) for bulimia nervosa. Her pulse is 100/min, and blood pressure is 130/80 mm Hg. Examination shows diaphoresis and dilated pupils. She is alert and cooperative but seems restless. She has not had hallucinations or suicidal ideation, She becomes angry 'When she is asked for the telephone numbers of her regular physicians. Serum amitriptyjine concentration is 150 mgldL, Urinalysis shows 0-2 RBClhpf, Which of the following is the most likely explanation for her symptoms?