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Hypoglycaemia requiring parenteral treatment — MCCQE Part 1 MCQ

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ModerateDiabetesHypoglycaemia requiring parenteral treatmentMCCQE Part 1

After eating home-canned food, a patient develops diplopia, ptosis, dysarthria, dry mouth and symmetric descending weakness. Sensation is intact and vital capacity is falling. What is the best next step?

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Correct answer: C — Obtain urgent antitoxin and provide respiratory support

Cranial neuropathies followed by symmetric descending flaccid paralysis after home-canned food strongly suggest foodborne botulism. Notify public health and the relevant antitoxin access program immediately and administer botulinum antitoxin as soon as possible on clinical grounds; antitoxin prevents further toxin binding but does not reverse established paralysis, so delay worsens outcome. Closely monitor vital capacity, bulbar function and secretion clearance, with early controlled ventilation when needed. Obtain serum, stool and food specimens without delaying treatment. Antibiotics are not routine for foodborne botulism, and pyridostigmine or corticosteroids do not neutralize toxin.

Reference: CDC Botulism Clinical Care: https://www.cdc.gov/botulism/hcp/clinical-care/index.html