Here is a concise summary of the provided text:
**Case Summary:**
* **Patient:** JD, a 27-year-old attorney with a history of mild depression (managed with quetiapine for 10 years)
* **Chief Complaint:** 9-day insomnia, severe nausea, and no bowel movements, leading to emergency room admission in an unconscious state
* **Diagnosis:** Acute Megacolon (enlarged colon) due to massive doses of diphenhydramine (taken for insomnia), causing:
+ Digestive system slowdown
+ Colon dilation
+ Perforation, leading to septic shock
* **Treatment:**
+ Emergency surgery to remove the colon
+ Intensive care unit (ICU) admission with antibiotics and resuscitation
* **Key Takeaway:** The patient's condition was caused by a preventable drug interaction (diphenhydramine + quetiapine) that should have been caught by healthcare providers, highlighting the importance of careful medication management.
Here are the key facts extracted from the text, without opinions, with each fact numbered and in short sentences:
**Patient Information**
1. JD is a 27-year-old woman.
2. JD is an attorney by profession.
3. JD was diagnosed with mild depression 10 years prior to the incident.
**Medical History and Treatment**
4. JD was prescribed quetiapine for her depression, which she took regularly for 10 years with good results.
5. JD started taking supplements for insomnia 3 months prior to the incident.
6. She later switched to over-the-counter (OTC) medication, specifically PM diphenhydramine, to help with sleep.
7. JD escalated her diphenhydramine dosage to 4-5 times the recommended amount to achieve sleep.
**Incident and Symptoms**
8. JD went 9 days without a bowel movement or adequate sleep before the incident.
9. She experienced severe nausea, stomach pain, and eventually became unresponsive.
10. JD's boyfriend, Jeff, found her unresponsive and called 911.
11. JD was admitted to the emergency room, where she was identified as being in shock.
**Medical Examination and Diagnosis**
12. JD's blood pressure was low, and her heart rate was elevated (150 beats per minute).
13. An abdominal CT scan revealed JD had Acute Megacolon.
14. The colon dilation was due to high doses of diphenhydramine, which slowed down her digestive system.
**Treatment and Outcome**
15. JD underwent immediate surgery, where her entire colon was removed due to perforation.
16. She was admitted to the intensive care unit (ICU) for treatment, including antibiotics and early goal-directed resuscitation.
17. JD's condition stabilized over the following days, and she eventually regained consciousness.
18. After several weeks, JD's septic shock was resolved, and her gut was surgically rejoined without her colon.