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Updated: Dec 22 2021

Botulism (Adult)

  • Snapshot
    • A 30-year-old woman presents to the emergency room for blurry vision. She reports that she had been watching a movie when she started seeing double and had difficulty swallowing her popcorn. She recently visited a farm, where she bought and consumed numerous pickles, jams, and cheeses. She states that her arms and face also feel weak. On physical exam, she has symmetric facial weakness, with drooping eyelids. She also has bilateral arm weakness, with loss of deep tendon reflexes.
  • Presentation
    • Symptoms
      • gastrointestinal upset in foodborne botulism
    • Physical exam
      • cranial nerve palsies
        • blurry vision
        • ptosis
        • facial weakness
        • drooping eyelids
        • 4 D’s
          • Diplopia
          • Dysarthria
          • Dysphagia
          • Dyspnea
      • autonomic nervous system dysfunction
        • dry mouth
        • postural hypotension
      • descending symmetric muscle weakness and flaccid paralysis
      • absent deep tendon reflexes
  • Studies
    • Labs
      • typically normal
      • toxin may be detected from serum, stool, or wound
        • process takes a few days, so this is only used as confirmatory testing
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Differential
    • Guillain-Barré syndrome
      • distinguishing factor
        • typically an ascending paralysis
  • Treatment
    • Management approach
      • immediate treatment with antitoxin
    • Medical
      • equine-derived heptavalent antitoxin
        • indication
          • patients > 1 years of age
  • Complications
    • Respiratory paralysis
    • Permanent paralysis
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