Botulism

Botulism, the grandaddy of food poisoning.  Botulism is the reason we don't buy dented cans.  And, more importantly, where Botox come from.  When people get botulism the outcome is not always good.  As with any potentially fatal illness early diagnosis is important. 

To help clinicians diagnose botulism we have the "Dozen D's":

1. Dry mouth;
2. Diplopia;
3. Dilated pupils;
4. Droopy eyelids;
5. Droopy face;
6. Diminished gag reflex;
7. Dysphagia;
8. Dysarthria;
9. Dysphonia;
10. Difficulty lifting head;
11. Descending paralysis; and
12. Dyspnea from diaphragmatic paralysis.

In any patient who displays three or more of the "Dozen D's" botulism should be considered.   Just the kind of thing we should be injecting to take care of wrinkles!  

Thank you to the AACT question of the day and Zane Horowitz.  (Horowitz BZ. Botulinum toxin 2005 Crit Care Clin 21:825-839)