Gender Ethnicracial And Life Span Considerations

Botulism has been observed in all age groups and equally in both genders; causative factors, however, may differ across the life span. C. botulinum is usually harmless to adults if ingested

140 Botulism while in the spore state, but not so in infants. Botulism occurs most commonly in infants ages 1 week to 11 months; peak susceptibility occurs at 2 to 4 months. Ethnicity and race have no known effect on the risk of botulism.

HISTORY. Elicit a history from the patient or parents regarding food consumption for the last 12 to 96 hours. Note that the incubation period ranges between 12 and 36 hours but depends on the amount of toxin the person ingested. Encourage the patient not only to identify the type of food but also to explain the food preparation with particular attention to the level of heat to which the food was exposed during preparation. Ask the patient if she or he has experienced any puncture wounds recently, particularly while gardening or working with soil.

Patients may describe symptoms of botulism within 12 hours of exposure. Initially, patients may describe nausea and vomiting, although often they remain alert and oriented without sensory or neurological deficits. Some patients report diarrhea or constipation, whereas others describe a very dry, sore throat and difficulty swallowing; some may experience GI symptoms prior to neurological symptoms, or the symptoms may occur simultaneously. Patients also describe neuromuscular abnormalities. Symptoms usually occur in a descending order from the head to the toes. Ask the patient if he or she has experienced blurred vision, double vision, difficulty swallowing, difficulty speaking, or weakness of the arms and legs.

PHYSICAL EXAMINATION. On inspection, the patient is often awake and alert but may be drowsy, agitated, and anxious. Usually, fever is absent.

Cranial nerve involvement occurs early in the disease course and leads to drooping eyelids, double vision, and extraocular muscle paralysis. Most patients lose their gag reflex, and fixed or dilated pupils occur in approximately 50% of patients as the disease progresses. Note if the patient has difficulty speaking. Inspect the symmetry of the facial expression. Evaluate the strength and motion of the extremities because weakness progresses to the neck, arms, thorax, and legs. Ask the patient to shrug her or his shoulders while you press gently on them to test for strength and symmetry. Check for respiratory depression and apnea. As the disorder progresses, respiratory muscle paralysis occurs from phrenic nerve involvement and the patient stops breathing.

Infants with botulism are lethargic, suck or nurse poorly, and are constipated. They are listless and have a weak cry, poor head control, and poor muscle tone due to muscle paralysis caused by the bacterial toxin, which can ultimately lead to paralysis of the arms, legs, trunk and respiratory muscles if the infection is untreated.

PSYCHOSOCIAL. Because of the potential for lifestyle changes and the lengthy hospitaliza-tion, children with botulism are at risk for alterations in growth and development. Assess the growth and development level in all age groups.

Diagnostic Highlights

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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