Thrombocytopenia is a common finding in septic shock patients in the intensive care unit (ICU). Various mechanisms have been attributed to explain the occurrence of thrombocytopenia, including disseminated intravascular coagulation (DIC) 1-3 , cytokine-driven haemophagocytosis of platelets 4,5 , immune-mechanisms, such as elevated plateletassociated IgG 1,6 , invasive catheters, especially pulmonary artery catheters 7,8 , and medications, such as heparin and pencillin analogues. Thrombocytopenia in critically ill patients, including trauma patients and surgical patients, has been found to be an independent marker for poor prognosis, increased bleeding, longer ICU stay and increased mortality 7-11. Most studies so far have explored the risk factors and clinical outcomes in critically ill medical, surgical, trauma or cardiac patients with thrombocytopenia. In this study, we looked at thrombocytopenic septic shock patients in a medical ICU. The objectives of the study were to study, 1) incidence of various degrees of severity of thrombocytopenia in septic shock, 2) risk factors for its development and 3) the correlation of thrombocytopenia with organ dysfunction, length of ICU stay and clinical outcome including mortality.

Patient: Female, 37 Final Diagnosis: Cardiac arrest due to Benzonatate overdose Symptoms: Cardiac arrest • respiratory deterioration • seizure Medication: Benzonatate Clinical Procedure: Intubation • hypothermia protocol Specialty: Critical Care Medicine Objective: Unknown ethiology Background: Benzonatate is one of the most widely prescribed nonnarcotic antitussives to relieve cough symptoms. As a structurally similar agent to other local anesthetics, including tetracaine and procaine, the risk to the public is not fully appreciated. Case Report: A 37-year-old female presented to the Emergency Department (ED) status post cardiac arrest. Advanced cardiac life support (ACLS) protocol was performed, and return of spontaneous circulation (ROSC) was achieved. Total downtime was 30 minutes. The patient was intubated, sedated, and hypothermia protocol was initiated. The patient developed bradyarrhythmia and mild coagulopathy suspicious for disseminated intravascular coagulation (DIC), thus hypothermia protocol was terminated later. A review of laboratory data showed acidosis with pH of 6.87, mixed acidosis secondary to high anion gap metabolic and respiratory acidosis with elevated liver enzymes. It was reported that approximately 2 hours prior to her presentation; the patient had ingested less than 30 pills of benzonatate 200 mg capsules with alcohol. Conclusions: Ingestion of benzonatate, a widely prescribed antitussive, may pose a risk to patients due to the potential for rapid development of life-threatening adverse events and limited treatment options in the overdose setting, not only in children but also in adults. Rational prescribing and patient education are needed.

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