Sample ER Protocol for Identifying Iatrogenic Botulism

Created by Megan McCue:

www.iatrogenicbotulism.com

***THIS IS NOT MEDICAL ADVICE; IT IS A SAMPLE PROTOCOL THAT HOSPITALS CAN USE/EDIT IN ORDER TO POTENTIALLY IDENTIFY CASES OF IATROGENIC BOTULISM***

If a patient presents to the emergency room with a sudden and new onset of at least 2 of the following:   

• Dizziness

• Blurry Vision

• Muscle weakness

• Difficulty swallowing

• Dry mouth

• Anxiety

• Cardiac complaints (elevated BP, chest pain/pressure)

• Shortness of breath complaints (can have normal O2 sats)

  
  

ASK: Have you received Botox (or another botulinum toxin product) in the past month?

If the answer is no: continue normal evaluation

If the answer is yes: conduct blood work and testing as usual, and call your state health department, or the CDC’s 24/7 phone line to speak with a botulism expert:

770-488-7100

Differential diagnosis:

Iatrogenic botulism is often misdiagnosed as Guillain-Barre syndrome, myasethnia gravis, psychiatric conditions, and stroke. These medical conditions should be ruled out prior to an iatrogenic botulism diagnosis.

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