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The patient was found with a drug packet labeled “Santa Muerte” in his pocket and had CNS and respiratory depression. He was given a complete of four mg of IN naloxone, after which he grew to become flushed, tachycardic, and agitated with dilated pupils. On arrival to the ED, his HR was 158 beats per minute, BP was 215/158 mmHg, RR was 26 breaths per minute, SpO2 was 99% on room air, and oral temperature was 102.1º F. He was given four mg of lorazepam and two mg of IV physostigmine, which treated his agitation. There was additionally marked enchancment in anhidrosis and urine retention.
