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His Sister's Keeper

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His Sister's Keeper is case #4 of House M.D. - Critical Cases.

Andrew Rostan, 42, suffers a seizure  is brought to the emergency room by a man calling himself "Cinnamon Dave" who quickly leaves after admitting that Rostan runs a methamphetamine lab.  The emergency room jumps to the obvious conclusion, but the tox screen is totally clear for methamphetamine and Rostan has a clear complexion and healthy teeth.  The case is assigned to Dr. House's team.

Dr. House sends his team to the meth lab where they do an environmental scan.  They find a prescription bottle.  After using 1 syringe, 5 chemical meds and 1 ward favor, they rule out laryngeal papillomatosis.

Dr. House sends the team back for another environmental scan.  They find a family photograph.  After spending $200 of the budget, they realize that Andrew is able to function in society, ruling out Oneiroid syndrome.

A third envrionmental scan has to be done in sillouette mode.  The team finds some chemical containers that are empty, they administer 2 IV Bags and spend another $200 of the budget.  Tests show there is no lithium in the lab, ruling out lithium poisioning.

The team approach Andrew to get permission to administer chelation for heavy metal poisoning, they find Andrew's sister Eileen, a science teacher, has come to visit him.  When they suggest chemical poisoning, she asks what could have caused it.  However, out of concerns for patient confidentiality, they dodge the question.

Andrew is treated with 1 gauze, 4 body mets and a ward favour, but the chelation has no effect.  He is soon suffering from an oculogyric crisis.  The tam administers intravenous antimuscarinic benztropine.

Andrew goes code blue and has to be defibrilated.

The team go back to the meth lab for another environmental scan.  They find a beaker for testing.  Andrew is treated with 7 head meds and a tongue depressor.  However, the beaker turns out to be brand new.  Once again, chemical poisoning is ruled out.

blood analysis finds metoclopramide, an antacid used to treat acid reflux.  The patient tests negative for omeprazole.  After using 2 thermometers and $250 of the budget, they realize the blood result doesn't explain the oculogyric crisis.  However, they do manage to rule out Grave’s disease.  

A further environmental scan, this time in the dark witha  flashlight, finds another prescription bottle, this one for antacids.  After using a ward favor and $250 of the budget, they realize the patient has had long term digestive problems, ruling out gastroenteritis as a possible diagnosis.

Andrew is given more imaging, but the scans are clean.  After using 8 gland meds, 1 tongue depressor and a ward favour, they realize that his dopamine levels are elevated, but they are not high enough to suggest fibromyalgia, which can be ruled out.

At this point, Dr. House wonders why none of the tests show any indication of exposure to methamphetamine.  Even if Andrew wasn't using, he should have been exposed if he was making the stuff.  He has a sudden realization and believes he knows what is wrong.  

He orders Andrew to be treated for metoclopramide poisoning with 1 oxygen mask, $400 of the budget, 1 ward favor and 9 digestive meds.  Andrew soon starts to recover.

House confronts the sister and catches her in an admission that she, not Andrew, was running the meth lab.  The family was short of money after Andrew's brother-in-law died.  The lab Andrew was in was a mock lab, explaining the total lack of chemicals there.  Andrews' real problem is that to save money because of his family's financial troubles, he tried to substitute metoclopramide for the omeprazole he was supposed to be taking, and kept the new meds in the old omeprazole bottle so his sister wouldn't know.  However, one of the reasons doctors don't often prescribe metroclopramide was because of it's neurological side effects.  Andrew would be fine once he switched to his original prescription.

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