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Step 1: View clinicals

A 30 year old woman presents with double vision, difficulty in swallowing, difficulty in speaking, and a dry mouth for 1 day, in a background of episodic nausea and vomiting for 2 days. Close questioning reveals a history of eating out 2 days ago along with 3 friends, one of whom was admitted to another hospital with similar symptoms just today. There is no history of alcohol abuse, recreational drug use or snake bite. Her medical and family histories are completely unremarkable.

Step 2: Order all relevant investigations

Electrodiagnostic Studies Upper Limbs

NCS shows a normal nerve conduction velocity and normal sensory nerve function. EMG shows a pattern of brief, small amplitude motor potentials, and an incremental response to repetitive stimulation seen on the high frequencies (20-50 Hz).

CSF Analysis

The CSF test results are within normal parameters.

Botulism Workup

A botulinum toxin screen of stools and serum is performed; results will be available in 2 days. Stool cultures for C. botulinum are obtained; results will be available in 2 weeks.

Anti-GQ1b Antibodies

The results will be available tomorrow.

Step 3: Select appropriate management

ICU care
IV Botulinum Antitoxin
IV Clindamycin

Score: ★★☆