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Breaking Bad Delirium: Methamphetamine and Boric Acid Toxicity with Hallucinations and Pseudosepsis

Kayla Johnson1, Joanna L Stollings1, E Wesley Ely1

  • 1From the Lipscomb University College of Pharmacy, the Department of Pharmaceutical Services, Vanderbilt University Medical Center, and the Division of Allergy/Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Veterans Affairs Tennessee Valley, Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee.

Southern Medical Journal
|February 4, 2017
PubMed
Abstract

Insights

Boric acid ingestion can mimic severe sepsis, causing profound shock and delirium. Early recognition of boric acid toxicity is crucial for accurate diagnosis and effective patient management.

Area of Science:

  • Toxicology
  • Emergency Medicine
  • Critical Care

Background:

  • Delirium and shock are critical conditions often associated with sepsis.
  • Pseudosepsis, a non-infectious condition mimicking sepsis, can be caused by toxic ingestions.

Observation:

  • A patient presented with hallucinations and shock, initially misdiagnosed as severe sepsis.
  • The patient had ingested boric acid (ant poison) and methamphetamine, leading to pseudosepsis and delirium.
  • Blue crystals around the nose and lips indicated boric acid exposure.

Findings:

  • Boric acid co-ingestion with methamphetamine induced profound pseudosepsis and sustained delirium.
  • Boric acid toxicity can present with symptoms mimicking severe sepsis, complicating diagnosis.

Implications:

  • Recognizing boric acid as a cause of unexplained delirium and shock is vital.
  • This case highlights the importance of considering toxic ingestions in patients with sepsis-like presentations.
  • Awareness of boric acid's potential toxicity can improve diagnostic accuracy and patient outcomes.

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