Botulism - Acute
Definition
A life-threatening neuro-paralytic disease produced by neurotoxins elaborated by Clostridium botulinum
Medical History
* Food poisoning due to Clostridia
* Wound of skin
* Illicit drug use
* Victim of bio-terrorism
Findings
* Apnea
* Shallow breathing
* Abdominal cramps
* Abdominal distension
* Abducens nerve weakness
* Abnormal vision
* Dysarthria
* Dysphagia
* Dyspnea - Acute
* Hypoactive gag reflex
* Muscle weakness
* Mydriasis
* Paralysis
* Tachypnea
* Abnormal deep tendon reflex
* Bladder distention
* Mentally alert
* Ptosis of eyelid
* Urinary retention
* Constipation
* Light intolerance
* Nausea and vomiting - Acute
* Pain in throat
* Xerostomia
Tests
Suspected botulism
* Clostridium botulinum toxin assay: Identification of Clostridium botulinum neurotoxin in specimens confirms the diagnosis of botulism .
Suspected wound botulism
* Clostridium botulinum culture: Clinical diagnosis of wound botulism can be confirmed by isolation of Clostridium botulinum; however, treatment should not be delayed for microbiologic results .
Suspected botulism
* Electromyography: Electromyography may document electrophysiologic abnormalities consistent with botulism before the results of specialized microbiologic tests are available .
Differential Diagnosis
* Guillain-Barré syndrome - Acute
* Cerebrovascular accident
* Meningitis
* Infant botulism - Acute
* Myasthenia gravis - Acute
* Foodborne botulism
* Food poisoning
* Wound botulism
* Tick paralysis
* Botulism - unclassified
* ARSENIC
* LEAD
* MERCURY, ORGANIC
* Inhalational botulism
Treatment
Drug Therapy
Botulism
BOTULISM ANTITOXIN
Ingestion of food or a pharmaceutical preparation known to contain botulinum toxin
ACTIVATED CHARCOAL
Adults: 50 to 100 g or 1 to 2 g/kg orally
Pediatrics (<1 year): 1 g/kg as slurry in water orally
Pediatrics (1-12 years): 25 to 50 g or 1 to 2 g/kg as slurry in water orally
Pediatrics (?13 years): 50 to 100 g or 1 to 2 g/kg orally
Procedural Therapy
Dehydration
* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .
Respiratory distress
* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .
Wound botulism
* Wound care: Wound botulism requires early, thorough wound irrigation and aggressive debridement .
Paralytic ileus
* Insertion of nasogastric tube
Reportable infectious diseases
* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .
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