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Author: Jessica Ross / Editor: Sarah Edwards / Codes: GP1, GP5, GP9, MHC1, PhC1, PhC4, PhP1, PhP2, PhP3, SLO1, SLO11, SLO2, SLO7 / Published: 03/07/2024

A 32-year-old male attends the Emergency Department (ED) complaining of right upper quadrant pain, nausea, diarrhoea and palpitations. His symptoms started 1 day ago, coinciding with beginning a self-medicated regime of Green Tea Extract for weight loss. The manufacturer dosing advice for his specific supplementation, was one tablet daily, containing 78.75mg Green Tea Extract, equivalent to 315mg Green Tea and containing 5.7mg caffeine. On day one he took 100 tablets, on day two he took a further 100 tablets. He discloses no suicidal intent or intent of self-harm. He has no other recent illness or infective symptoms.

He has a prior history of alcohol excess, however, has been abstinent for the past two months. Otherwise, he takes propranolol for palpitations.

On examination, he is anxious and jittery. He has fast, regular radial pulses. Otherwise, cardiorespiratory examination is normal. He has no peritonism, but RUQ tenderness on examination without guarding. There is no evidence of jaundice or hepatomegaly. He has a normal neurological examination.

Vital signs on arrival to the Emergency Department are as follows:

  • Blood pressure 155/94
  • Heart rate 153, regular
  • Respiratory Rate 25
  • Oxygen saturation 96%
  • Temperature 36.4

His ECG shows a sinus tachycardia with normal QTc.

A venous blood gas reveals a mild metabolic alkalosis, pH 7.47, HCO3 27.5 with a lactate of 2.3 mmol/L.

Laboratory blood testing shows WCC of 20.61 (x 10^9/L), Neutrophils 13.58 (x10^9/L), ALT of 63 U/L, Phosphate 3.69 nmol/L and Ammonia 45 umol/L. Other laboratory testing is unremarkable.

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