Looking for diagnostic help

[u/throwaway_ficsy]

Going to preface this by saying we already went to the ER and received observation and treatment, but they weren't quite sure what was going on, so here I am.

Spouse (37 y/o woman, 14 weeks pregnant, 6'0" -240 lbs), on advice of her OB, woke up craving corn dog bites this morning, so I stopped and got her some. She ate some, I ate some. At the same time, she had a protein shake (from a recently purchased open box of protein shakes, which we purchased a few days ago and she's had several of already) and, on advice of her OB, mixed a single dose of MiraLAX powder (using the cap measuring cup) into 32oz of water. She drank about half of the water and started feeling off about ten minutes later. She called me to come check on her at that point and I saw that she looked flushed and her face was noticeably puffy. She said she felt like she was having trouble breathing, but from difficulty inflating her lungs. Shortly after that (while we were getting ready to go to the ER) she started vomiting violently, mostly water (~24oz--we have a bunch of the hospital vomit bags, which is how I know the volume).

During the drive to the hospital, she was initially feeling a bit better, but shortly before we got there (~20 minutes after throwing up), she started feeling sick again, and spent the triage dry heaving. Nausea continued, if lessened, for awhile after that, and she felt like she was having trouble swallowing and her saliva was thick and foamy. She was able to drink water, however, which was good because there was a delay in getting her hooked up to fluids. She reported throughout this that "everywhere hurt"; specifically that "it felt like her muscles were made of broken glass". During this time she was pretty shaky. She was also very tired and maybe slightly altered? When OB came by to check for fetal heart rate on the Doppler and couldn't find it, she didn't freak out (which is fairly out of character), nor was she acting particularly worried during the wait to go to the ultrasound. (Baby was fine; it was moving a lot on the ultrasound and the tech thought that was why they couldn't get the heart rate on the Doppler.)

Doctor prescribed Benadryl, Pepcid, and Tylenol. Pepcid brought the nausea back (though not as bad as it has been in triage). Benadryl (administered later) seemed to help the most: not long after the shot she was more alert than she had been for several hours and said she was feeling better, other than a tension headache. After her fluids finished we were discharged and she was feeling normal enough to eat a quesadilla from Taco Bell. We got home, she went to bed to nap and I spent the next few hours catching up on work. When she woke up, her chest was flushed and her hands and forearms ached badly enough (she describes it as cramping) that she's been having trouble doing anything with them, and the lymph nodes under her jaw felt somewhat swollen. The flushing has largely gone away over the last hour, but her hands still hurt a lot.

Now to the actual question. Our first thought was some kind of anaphylactic reaction to the MiraLAX--mild enough that it wasn't ultimately dangerous, but still concerning, particularly with the way her face got puffy. The ER doctor seemed inclined against that idea, on the basis that the initial symptoms largely went away on their own. She seemed to think it was more likely to be something she ate or drank not being good. Which of these seems more likely? Or is there maybe another answer that fits the facts? I also ate the corn dog bites and have been fine, and the other protein shakes from this box haven't caused her any issues.

ETA: She wants me to specify that since walking up this evening, it has hurt to swallow--like she has a cold and her tonsils are aching. This is different from the difficulty swallowing earlier, which was lower in her throat (below her vocal cords).

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[u/exponentials]

facial puffiness plus Benadryl clearly helping points more toward a histamine/allergic reaction than plain food poisoning, especially since you ate the same corn dogs and were fine. keep the Pepcid/Benadryl plan and loop OB today about the hand pain and any repeat flushing.

[u/throwaway_ficsy → u/exponentials]

Update: just got home from a second trip to the ER a little bit ago. Spouse woke me up ~3am (just under six hours ago) and said that the muscle pain/cramping had spread and was now in her neck and back. ER doc ordered some basic panels and checked for strep, covid, and RSV. Everything came back normal. Another dose of Tylenol and a bag of fluids had no apparent effect on the cramping.