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(8/21/93 note of Intern in Emergency Room, continued)
Labs       ASA(aspirin) neg  12.9
               Ca(lcium)      9.4  26.2             17.7>--<253          137---101---14<84
               Mg(nesium)   2.0                               44    89             4.1    21      1.2
Imp(ression) Elavil toxicity in a 23 year old male on elavil for approximately 2 weeks
		      Neuro-characteristic seizure activity based on description following elavil
				 vsc(?vascular) Levels, pending. The prolongation of the QRS is consistent
                                 with amitriptylene toxicity
                                 (?)AMP(?ampule) HCO3 (bicarbonate) to protect heart
             Tox(icology)-Denies suicide attempt but ASA(aspirin), Tylenol     X(within normal limits)
                                  Urine for toxicology sent    
   CV(cardiovascular)-Wide QRS treated with HCO3
                                   Follow on telemetry                              / (initials-Noah Berkowitz) 7089
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8/22/93      Attending
   23 year old male with history of Anxiety Depression, started on
   Tricyclic ~(approximately) 2 weeks Ago. S/P (status post) Generalized Seizure yesterday,
   getting contusions to Face, Exam(ination) otherwise unremarkable. EKG shows QRS>10
   (?)  CT (scan) Negative
      New onset Seizure   ? due to Amitriptylene vs(versus) New onset seizure Disorder
      (vs head trauma, less likely).  Patient to be monitored X (for) 24 hours;
       Neurology to See.
                                                                                         R. Goodman
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8/22/93                      IPN(?)   (Only Intern Berkowitz note on Sunday, day after admission)
	Patient doing well
	Neg Complaint Of, (?),CP(Chest Pain), palpitations dizziness N(nausea?Vomiting)
        H(eart)R(ate)  100-110, (?) vss(?) afebrile
	C(ardio)V(ascular) - unchanged.
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