SHM Converge Scientific Abstract ePoster Gallery-When Toxidromes Collide

Pdf Summary

A 43-year-old woman with a history of generalized anxiety disorder, ADHD, benzodiazepine dependence, and multiple prior admissions for tianeptine abuse/withdrawal presented to the ED with nausea, diarrhea, diaphoresis, agitation, confusion, and altered mental status. Her husband brought her in because she was disoriented and could not recall the previous three days. She also reported restlessness and muscle tension.<br /><br />On exam, she was not oriented to time, place, or situation and was distractible and confused. Her vital signs were stable, without fever or tachycardia. Further history revealed that she had been purchasing powdered tianeptine online and ingesting it “by the spoonful” for about a year, using it for weight loss and its euphoric effects. Her past withdrawal episodes had included benzodiazepine use, seizures, tachycardia, and hallucinations.<br /><br />The presentation was consistent with tianeptine withdrawal, which can mimic opioid withdrawal or other toxidromes. Key symptoms include tachycardia, myalgia, gastrointestinal upset, anxiety, diaphoresis, agitation, and altered mental status. This case highlights the importance of asking about supplement and online substance use in patients with unexplained withdrawal-like symptoms, especially when there is a history of substance use disorder.

Asset Subtitle

Ann E. Yacoubian

Meta Tag

Author List Ann E. Yacoubian, Megan Brooks, Stephanie Nguyen

Category Clinical Vignettes

Concept Tianeptine Withdrawal

Concept Tianeptine Misuse

Concept Opioid-like Withdrawal

Concept Altered Mental Status

Concept Substance History

Distinguished Non-Finalist

Presenter Organization Ochsner Clinical School

Presenting Author Ann E. Yacoubian

Track Adult

Keywords

tianeptine withdrawal

altered mental status

benzodiazepine dependence

substance use disorder

opioid withdrawal mimic

agitation

diarrhea

diaphoresis

online drug use

withdrawal symptoms

Tianeptine Withdrawal

Tianeptine Misuse

Opioid-like Withdrawal

Altered Mental Status

Substance History