This rare disease produced by the toxin of one of the bacteria of the clostridium genus crept into the differential of possibilities on a young patient I saw this week who presented extremely fatigued. The term is thrown around at parties. But now you can be an expert.


If you suspect this, take the patient to the emergency room immediately. Don’t try to diagnose it. Don’t try to treat it. Because even if it isn’t botulism that plagued your bachelorette party, it’s something that does need attention — by a physician.


The toxin I mentioned above inhibits acetylcholine release. You might remember from grade school biology that the brain is over 90% cholinergic. Cholinergic means driven by the neuroreceptor acetylcholine. Yes. That means that botulism is affecting over 90% of your neural function.

Three classic presentations almost always involve some food, an infant, or a wound.

The pneumonic you need to remember is “D‘s“:
Diplopia. This is first, so the top of the list.
Dilated pupils (so, unlike myasthenia gravis).
Dysuria (secondary to urinary retention).
Descending symmetrical paralysis

And you guessed it:
Death 2° <-respiratory Dysfunction.

Some really bad food, a super sick infant, or an infected wound. Good luck keeping an eye out for botulism. Stay well.