Diagnostic Considerations

Other problems to be considered in the differential diagnosis include the following:

Allergic reaction
True disulfiram reaction
Other disulfiramlike reactions from medications (eg, metronidazole, oral hypoglycemic agents, tacrolimus, cephalosporins)
Other disulfiramlike reactions from occupational exposures (eg, carbon disulfide, carbon tetrachloride, thiram fungicides)
Carriage of an inactive form of alcohol dehydrogenase (present in many people of East Asian descent—eg, China, Japan, Indonesia, Vietnam29)

Differential Diagnoses

Alcohol and Substance Abuse Evaluation
CBRNE - Botulism
Cutaneous Manifestations of Cholesterol Embolism
Emergent Management of Bulimia Nervosa
Emergent Treatment of Gastroenteritis
Esophageal Rupture and Tears in Emergency Medicine
Gyromitra Mushroom Toxicity
Hyperventilation Syndrome
Hypovolemic Shock
Orellanine Mushroom Toxicity
Organic Phosphorous Compound and Carbamate Toxicity
Panic Disorder
Sunburn
Toxic Shock Syndrome
Toxicity, Mushroom - Amatoxin
Toxicity, Scombroid

Workup

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Author

Stephen L Thornton, MD Associate Clinical Professor, Department of Emergency Medicine (Medical Toxicology), University of Kansas Hospital; Medical Director, University of Kansas Hospital Poison Control Center; Staff Medical Toxicologist, Children’s Mercy Hospital

Stephen L Thornton, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Chief Editor

Sage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center

Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

B Zane Horowitz, MD, FACMT Professor, Department of Emergency Medicine, Oregon Health and Sciences University School of Medicine; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System

B Zane Horowitz, MD, FACMT is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

C Crawford Mechem, MD, MS, FACEP Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Michael Hodgman, MD Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.