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A 43-year-old woman with amyotrophic lateral sclerosis had been treated with riluzole for two years, during which she had lost 8 kg in weight. She was able to walk with support, she could feed herself and had rare difficulty swallowing, and she had mild dysarthria. Her forced vital capacity was 47 percent of the predicted value, and she was depressed. She was hospitalized six hours after deliberately ingesting 2.8 g of riluzole. On admission, physical examination revealed dyspnea, a pulse rate of
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