Title: Poison
Original airdate1/25/05
Episode: 108
Synopsis:
Patient: Matthew Davis, Chi Ling
Initial symptoms: disorientation, nausea

*****Spoilers below*****

Differential diagnosis:

During an AP Calculus exam, a  teenage boy experiences disorientation, and has difficulty communicating. He tries to rise to go to the bathroom, but collapses to the floor.

Foreman presents the case to House, noting that Matt's symptoms now include severe bradycardia, with a heart rate of only 48 and still falling, and is not responding to atropine. House attempts to brush aside the case with a snap diagnosis of drugs, for which he needs charcoal and naloxone, and tells Foreman to leave him alone. Foreman says the tox screen was clean, and House becomes interested in Foreman's interest.  House suggests that Foreman doesn't care about the kid himself, just the interesting illness. Foreman persists, noting a clean CAT scan, no infection, and no diabetes.

Cameron suggests shigellosis, but Foreman notes it wouldn't explain the bradycardia. Chase suggests viral myocarditis, but House points out it wouldn't account for the disorientation ("whacked-out"). House becomes interested in the negative tox screen.  The team lists the possiblilities that the boy was clean, someone botched the test, or he used something that isn't tested for. Chase says that 1,4-Butanediol would produce the same symptoms. House explains that the chemical, which is found in copier toner, would have the same effect as GHB, though it is more expensive and more dangerous, it is easier to obtain. House sends Foreman and Cameron to search Matt's home. House orders Chase to double Matt's dose of atropine from 1ml to 2ml.

Chase attempts to question Matt about drugs, but Matt cannot respond. Matt's mother, Margo, insists that Matt doesn't take drugs. Chase points out that if Matt did take drugs, his mother most likely wouldn't know about it. Margo tells him that she tested Matt herself with a home kit.  Margo says all Matt did the night before was study and argue with her about school and personal choices.

While they are talking, Matt begins to seize. Chase orders 10 milligrams of diazepam.

During the search of the home, Cameron finds a jar of homemade tomato sauce with a bulging lid, which is a sign of bacterial contamination. Foreman finds an identical open jar in the fridge, and finds out that Matt made himself a pizza for a snack the night before.  Cameron says the sauce could contain botulism, or one of many other toxins which would cause gastroenteritis, cardiac symptoms, and confusion.  House dips a tongue depressor in the sauce, to Cameron's surprise, and eats a large dollop.

House says Matt's seizures rule out food-borne toxins. Foreman adds that the seizures also rule out drug use because they started two hours after Matt's admission.  When asked what the seizures add to the equation, Cameron suggests pesticide poisoning. Carbamates, organophosphates, and organochlorines are mentioned as possibilities. Foreman says they can't tell yet if the poison was inhaled or absorbed, and Cameron suggests that Matt be washed in case there is any pesticide residue left on his skin. House says he already asked the nurses to do so.

An hour later, Margo is at Matt's side, fretting that the medication does not appear to be working. Chase tells her that the medication, Pralidoxime, is very effective, but takes more time to work. She questions whether they have the right diagnosis, but Chase assures her that the bloodwork was conclusive for organophophate poisoning. Matt's heart rate drops to 30. Chase calls to the nurses who rush in that Matt is in bradycardic arrest and needs pacing pads to beat his heart. Application of the pads brings Matt's heart rate up to 56.

Chase tells her they will keep Matt on the pads for another hour, and see what his condition is.
Margo wants to know what happens next. She is not happy about the "wait and see" approach, and wants to know is there are other options.

Back in the office, Chase tells House and the team that the Pralidoxime is not working, and they'll have to wire Matt's heart. While discussing options, Foreman mentions an experimental treatment developed by one of his medical school professors for the army. The treatment involves a hydrolase for targeted for each poison. For the treatment to work, they'll need to know which poison Matt was exposed to, and which hydrolase to ask for. In unison, House and Foreman suggest getting them all.

Foreman suggest figuring out how Matt was exposed so they can find out what he was exposed to. House supposes the homemade tomato sauce came from home-grown tomatoes from the Davis' vegetable garden.

Chase inserts a pacing wire into Matt's heart while Cameron returns to Matt's home. Cameron finds an empty can of disulfoton in the garden shed. Margo tells Chase the garden is an experiment in organic farming, and the can contained only orange peel oil.  Margo asks what will happen if Matt is given the wrong hydrolase. Chase tells her that it may make him worse, but insists they are not wrong about the poison. Margo refuses to allow the treatment.

House attempts to get Cuddy or the hospital lawyers to override Margo's decision, but fails. All Cuddy suggest is having Margo sign papers refusing the treatment. House brings the papers to Margo and reads her the legalese, somewhat altered, and bullies her into allowing the treatment by convincing her Matt will "kick off" without it.

House orders the treatment, but Cameron brings him to the room of another boy who just arrived at the hospital in serious condition with the same symptoms as Matt.

Margo requests that Chase be removed from Matt's case, and Foreman takes over Matt's care. Foreman attempts to defend House's actions to Margo, which leads her to declare that Foreman is just as "pompous and superior" as House.

The boys live ten miles apart, are in different grades, go to classes in different buildings, and eat in different cafeterias, but they both ride the same bus to school.  Chase and Cameron discover that the county sprayed ethyl-parathion along the bus route due to concerns about West Nile.

They have the hydrolase for ethyl-parathion, but neither Foreman nor Chase believe they will be able to convince Margo to accept the treatment. She faxed Matt's records to the CDC for a second opinion. House sends Cameron to speak to Margo, who is now considering transferring Matt to another hospital. Cameron makes an attempt at sympathetic bonding, but Margo brushes it aside. Cameron harshly tells Margo that without the treatment, her son will die, and she needs to decide, right now.

Margo allows Cameron to administer the hydrolase, which is also given to Chi. Both boys have seizures and are given diazepam. Foreman tells House the condition of both boys has worsened. Their hearts and lungs have weakened further, and they are now showing liver toxicity. House asks Foreman what the severity of the cadiac symptoms reveal, to which Foreman replies the poison was probably absorbed through the skin.  Since the absortion would take anywhere from one to four hours, House thinks the boys were poisoned before they got on the bus, from something in their homes. House sends Cameron and Foreman to search their homes for anything containing lanolin, or anything that may have touched their skin that morning.

Cameron and Foreman check the shampoos, shaving creams, air fresheners, etc. in both homes. They discover that both homes have the same laundry detergent, but Chi's parents tell House that their son doesn't do laundry, and his clothes were new, and had never been washed. House and Chase retrieve Matt's clothes from storage to find that while the jeans look old, the tag looks new. House sends the clothes for testing.

Foreman discovers the boys' jeans were contaminated with phosdrin. Chi's parents agree to the treatment, but Margo does not.  Margo will not agree to anything until she hears from the CDC.  House brings his little TV into Matt's room and sets the bottle of hydrolase down in front of Margo. Margo's phone rings. She has a brief conversation, and tells House the call was from the CDC, and they can't help her. House begins to speak, but Margo abruptly tells House to give Matt the treatment.

In the hallway, Chase returns House's phone. Chase called Margo, pretending to be from the CDC. House is astonished that Chased fooled her with an atrocious Southern accent.


In time, both boys wake up. Matt fears a rebuke from his mother for buying stolen jeans from the back of a truck, but she says shes just glad he's alive. The man who sold the jeans to Matt and Chi also worked at a cornfield. He spilled the pesticide on the jeans, and didn't bother to wash them.

Margo runs into House and Foreman in the hall, and tells him that the real CDC called. Margo says nothing, but walks away smiling. When Matt asks who they were, she tells him, "They're the arrogant jerks that saved your life."




Diagnosis
:
Organophosphate poisoning


Soap Opera
:

While searching the Davis' home, Foreman postulates that House wants a drug diagnosis (and to believe that Foreman used drugs in the past) because House himself is a drug addict.  Cameron asks Foreman if he really never did any drugs, but he brushes her comments aside with a joke, which Cameron
notes is House-like behavior.  Foreman denies his "Houseishness," but cannot deny that he is wearing sneakers identical to House's.

Margo thinks House and his team are incredibly arrogant, which is not unfair. Chase refused to listen to her, and Foreman told her he was right to do so, even though their medical advice was wrong. Cameron's approach was condescending, then harsh. Margo justifiably did not trust their most recent advice, and told them they had to do better, but Cameron shifted the responsibility to Margo. House just browbeat her until he got his way, as usual. They saved Matt and Chi, but they were indeed arrogant jerks.


Clinic Patients:

Georgia Adams

Everybody Lies:


.
People: 

Margo Davis
Mrs. Miller
Mark Adams
Nurse
Dr. Morell (unseen, paged to the CAP lab)
Chou-Young Ling
Jen Ling
Amy
Math Whiz
Bus Driver

Incidental terms:
DSW
IVPB
chalamydia
syphilis
Orthene
malathion
superior vena cava
atrium
tricuspid valve
ventricle

Home | Medicine | People | Episodes