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Almeida M, Mugford A, Defauw P. Successful Use of Mycophenolate Mofetil as Adjunct to Prednisolone for Treatment of Acute Kidney Injury Secondary to Human Serum Albumin Administration in a Dog. J Am Anim Hosp Assoc 2023; 59:45-50. [PMID: 36584313 DOI: 10.5326/jaaha-ms-7287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
Abstract
The use of human serum albumin (HSA) is described in dogs receiving critical care. However, despite the high degree of homology, anaphylactic and delayed hypersensitivity reactions are reported. Delayed type III hypersensitivity reactions can lead to glomerulonephritis and acute kidney injury (AKI). Undiluted 20% HSA was administered to a 4.8 yr old intact male Labrador Retriever with severe hypoalbuminemia, following surgical management of septic peritonitis of gastrointestinal origin. Nineteen days after HSA administration, the dog developed peracute high magnitude renal proteinuria and AKI. Rapid immunosuppression, using a combination of prednisolone and mycophenolate mofetil, resulted in full resolution of AKI, hypoalbuminemia, and proteinuria. Addition of mycophenolate mofetil may have resulted in the first documented case of full renal recovery from hypersensitivity-induced AKI caused by HSA administration.
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Affiliation(s)
- Mariana Almeida
- From Lumbry Park Veterinary Specialists, Alton, United Kingdom (M.A., P.D.)
| | - Adam Mugford
- Anderson Moores Veterinary Specialists, Linnaeus, Mars Veterinary Health, Winchester, United Kingdom (A.M.)
| | - Pieter Defauw
- From Lumbry Park Veterinary Specialists, Alton, United Kingdom (M.A., P.D.)
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2
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Bruns N, Dohna-Schwake C. Antibiotics in critically ill children-a narrative review on different aspects of a rational approach. Pediatr Res 2022; 91:440-446. [PMID: 34873285 PMCID: PMC8816725 DOI: 10.1038/s41390-021-01878-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022]
Abstract
Especially critically ill children are exposed to antibiotic overtreatment, mainly caused by the fear of missing out a severe bacterial infection. Potential adverse effects and selection of multi-drug resistant bacteria play minor roles in decision making. This narrative review first describes harm from antibiotics and second focuses on different aspects that could help to reduce antibiotic overtreatment without harming the patient: harm from antibiotic treatment, diagnostic approaches, role of biomarkers, timing of antibiotic therapy, empiric therapy, targeted therapy, and therapeutic drug monitoring. Wherever possible, we linked the described evidence to the current Surviving Sepsis Campaign guidelines. Antibiotic stewardship programs should help guiding antibiotic therapy for critically ill children. IMPACT: Critically ill children can be harmed by inadequate or overuse of antibiotics. Hemodynamically unstable children with a suspicion of infection should be immediately treated with broad-spectrum antibiotics. In contrast, in hemodynamically stable children with sepsis and organ dysfunction, a time frame of 3 h for proper diagnostics may be adequate before starting antibiotics if necessary. Less and more targeted antibiotic treatment can be achieved via antibiotic stewardship programs.
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Affiliation(s)
- Nora Bruns
- grid.5718.b0000 0001 2187 5445Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. .,Westdeutsches Zentrum für Infektiologie, University of Duisburg-Essen, Essen, Germany.
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3
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Arulkumaran N, Routledge M, Schlebusch S, Lipman J, Conway Morris A. Antimicrobial-associated harm in critical care: a narrative review. Intensive Care Med 2020; 46:225-235. [PMID: 31996961 PMCID: PMC7046486 DOI: 10.1007/s00134-020-05929-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022]
Abstract
The belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.
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Affiliation(s)
| | - Matthew Routledge
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Sanmarié Schlebusch
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Forensic and Scientific Services, Queensland Health, Brisbane, Australia
| | - Jeffrey Lipman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Intensive Care Services, Royal Brisbane and Womens' Hospital, Brisbane, Australia.,Scientific Consultant, Nimes University Hospital University of Montpellier, Nimes, France
| | - Andrew Conway Morris
- John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK. .,Division of Anaesthesia, Department of Medicine, University of Cambridge, Level 4, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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4
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Moran R, Devchand M, Smibert O, Trubiano JA. Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling. Br J Clin Pharmacol 2019; 85:492-500. [PMID: 30521088 DOI: 10.1111/bcp.13830] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/04/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022] Open
Abstract
Antibiotic allergy labels (AALs) are reported by approximately 20% of hospitalized patients, yet over 85% will be negative on formal allergy testing. Hospitalized patients with an AAL have inferior patient outcomes, increased colonization with multidrug-resistant organisms and frequently receive inappropriate antimicrobials. Hospitalized populations have been well studied but, to date, the impact of AALs on patients with critical illness remains less well defined. We review the prevalence and impact of AALs on hospitalized patients, including those in in critical care.
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Affiliation(s)
- Rebekah Moran
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia
| | - Misha Devchand
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia.,Department of Pharmacy, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Smibert
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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5
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Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, Shibayama K, Umezawa K, Kiriu N, Kato H, Koido Y, Inoue J, Kawakita K, Kuroda Y. Venomous snake bites: clinical diagnosis and treatment. J Intensive Care 2015; 3:16. [PMID: 25866646 PMCID: PMC4393627 DOI: 10.1186/s40560-015-0081-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/09/2015] [Indexed: 11/21/2022] Open
Abstract
Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. Here we review the literature to present the proper management of bites by mamushi, habu, and yamakagashi snakes, which widely inhabit Japan and other Asian countries. No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. Mamushi (Gloydius blomhoffii) bites cause swelling and pain that spreads gradually from the bite site. The platelet count gradually decreases due to the platelet aggregation activity of the venom and can decrease to <100,000/mm(3). If the venom gets directly injected into the blood vessel, the platelet count rapidly decreases to <10,000/mm(3) within 1 h after the bite. Habu (Protobothrops flavoviridis) bites result in swelling within 30 min. Severe cases manifest not only local signs but also general symptoms such as vomiting, cyanosis, loss of consciousness, and hypotension. Yamakagashi (Rhabdophis tigrinus) bites induce life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype, resulting in hypofibrinogenemia and increased levels of fibrinogen degradation products. Previously recommended first-aid measures such as tourniquets, incision, and suction are strongly discouraged. Once airway, breathing, and circulation have been established, a rapid, detailed history should be obtained. If a snake bite is suspected, hospital admission should be considered for further follow-up. All venomous snake bites can be effectively treated with antivenom. Side effects of antivenom should be prevented by sufficient preparation. Approved antivenoms for mamushi and habu are available. Yamakagashi antivenom is used as an off-label drug in Japan, requiring clinicians to join a clinical research group for its use in clinical practice.
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Affiliation(s)
- Toru Hifumi
- />Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan
| | - Atsushi Sakai
- />The Japan Snake Institute, Yabuzuka 3318, Ota, Gunma, 379-2301 Japan
| | - Yutaka Kondo
- />Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara, Okinawa, 903-0215 Japan
| | - Akihiko Yamamoto
- />Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama, Tokyo, 208-0011 Japan
| | - Nobuya Morine
- />Okinawa Prefectural Institute of Health and Environment, 2085 Ozato, Ozato, Nanjo, Okinawa, 901-1202 Japan
| | - Manabu Ato
- />Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640 Japan
| | - Keigo Shibayama
- />Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama, Tokyo, 208-0011 Japan
| | - Kazuo Umezawa
- />Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
| | - Nobuaki Kiriu
- />Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan
| | - Hiroshi Kato
- />Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan
| | - Yuichi Koido
- />Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan
| | - Junichi Inoue
- />Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi, 400-8506 Japan
| | - Kenya Kawakita
- />Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan
| | - Yasuhiro Kuroda
- />Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan
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Abstract
Cutaneous drug eruptions can range from an asymptomatic rash to a life-threatening emergency. Because of the high frequency, morbidity, and potential mortality associated with drug eruptions, patients with possible drug reactions should promptly be recognized, worked up, and treated. Drug reactions are common in the elderly population due to age-related alterations in metabolism, excretion of medications, and polypharmacy. This review discusses the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of drug eruptions that providers commonly encounter in the care of the geriatric population. An algorithm for an approach to patients with a suspected drug eruption is presented.
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Affiliation(s)
- Ammar M Ahmed
- Department of Dermatology, University of Texas-Southwestern Medical Center-Austin Campus, University Medical Center Brackenridge, Seton Healthcare Family, 601 East 15th Street, CEC C2.443, Austin, TX 78701, USA.
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Powell C, Thompson L, Murtaugh RJ. Type III hypersensitivity reaction with immune complex deposition in 2 critically ill dogs administered human serum albumin. J Vet Emerg Crit Care (San Antonio) 2013; 23:598-604. [PMID: 23941553 DOI: 10.1111/vec.12085] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe 2 cases of vasculitis that were attributed to a type III hypersensitivity reaction in critically ill dogs occurring 8-16 days postadministration of human serum albumin (HSA). CASE OR SERIES SUMMARY Skin biopsies were obtained from 3 different sites in 2 critically ill dogs that developed vasculitis 8-16 days following treatment with HSA. Histopathological findings from both dogs indicated epidermal pallor, widespread edema and hemorrhage, degenerative neutrophilic perivascular infiltrates, and multifocal areas of neutrophilic or leukocytoclastic vasculitis. Immunohistochemical staining using an anti-human serum albumin rabbit antibody suggested that the antigen-antibody complexes seen in the dermis were associated with the administration of HSA. NEW OR UNIQUE INFORMATION PROVIDED In this case series, we documented a leukocytoclastic vasculitis and probable antigen-antibody complexes to human albumin in the dermis of 2 critically ill dogs after administration of HSA. Previously, type III hypersensitivity reactions had only been reported in healthy dogs that had received HSA. This report also describes the potential use of immunohistochemical staining to detect the HSA antigen in tissue sections through the use of specifically labeled antibodies.
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Yoshioka W, Mori T, Nagahama K, Tamura T. Biopsy-proven drug-induced tubulointerstitial nephritis in a patient with acute kidney injury and alcoholic severe acute pancreatitis. BMJ Case Rep 2013; 2013:bcr-2013-008557. [PMID: 23645698 DOI: 10.1136/bcr-2013-008557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We report a 49-year-old man with alcoholic severe acute pancreatitis (SAP) complicated by drug-induced acute tubulointerstitial nephritis (DI-AIN). Oliguria persisted and became anuric again on day 17 despite improvement of pancreatitis. He presented rash, fever and eosinophilia from day 20. Renal biopsy was performed for dialysis-dependent acute kidney injury (AKI), DI-AIN was revealed, and prompt use of corticosteroids fully restored his renal function. This diagnosis might be missed because it is difficult to perform renal biopsy in such a clinical situation. If the patient's general condition allows, renal biopsy should be performed and reversible AKI must be distinguished from many cases of irreversible AKI complicated by SAP. This is the first report of biopsy-proven DI-AIN associated with SAP, suggesting the importance of biopsy for distinguishing DI-AIN in persisting AKI of SAP.
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Affiliation(s)
- Wakako Yoshioka
- Department of Nephrology, Yokosuka Kyosai Hospital, Yokosuka, Japan.
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Abstract
PURPOSE OF REVIEW This article aims to make a review of the up-to-date knowledge on anaphylaxis and outline the recent advances on pathophysiology, diagnosis, and management of anaphylaxis. RECENT FINDINGS New data confirm the increase in prevalence of anaphylaxis and emphasize immunopathologic mechanisms. However, anaphylaxis is often underdiagnosed and guidelines are poorly applied, particularly in emergency departments. SUMMARY An improvement of rapid diagnosis and treatment combined with education of population will decrease mortality and morbidity of anaphylaxis.
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11
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12
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Young N, Clark D, Cook B. The Management of Antihypertensive-Associated Angioedema: When Necessary, Conventional Tracheal Intubation can be Successful. J Intensive Care Soc 2012. [DOI: 10.1177/175114371201300108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are known to be associated with angioedema. These drugs are widely prescribed for hypertension and left ventricular dysfunction, in accordance with NICE guidance. There have been several case series published pertaining to angioedema associated with antihypertensives originating from allergy clinics and emergency departments, but very few from critical care. We present a case series describing the presentation and critical care management of this group of patients. We found that 5 of 16 (31%) patients required tracheal intubation, with only one of these having an awake fibreoptic intubation. Fifteen out of 16 (94%) of these patients survived to hospital discharge. Previous authors have suggested that these patients should always be managed with awake fibreoptic intubation. Our data, although with limited numbers, challenge this approach.
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Affiliation(s)
- Neil Young
- Consultant in Intensive Care Medicine, General Intensive Care Unit
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Donna Clark
- Specialist Trainee in Emergency Medicine, Emergency Department
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Brian Cook
- Consultant in Intensive Care Medicine, General Intensive Care Unit
- Royal Infirmary of Edinburgh, Edinburgh, UK
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Jen SPP, Sharma R, Kochar S. Probable acyclovir-induced angioedema in a patient with HIV infection and suspected varicella-zoster virus encephalitis. Am J Health Syst Pharm 2011; 68:2257-60. [PMID: 22095814 DOI: 10.2146/ajhp100639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A probable acyclovir-associated hypersensitivity reaction resulting in severe facial angioedema and respiratory distress is reported. SUMMARY A 51-year-old woman with human immunodeficiency virus (HIV) infection and end-stage renal disease arrived at the emergency department (ED) with a diffuse rash on the chest and back; she was diagnosed with varicella-zoster virus infection, received one dose of i.v. acyclovir, and was discharged home with a prescription for valacyclovir. After taking one dose of the drug, she became confused and agitated. The next day the patient returned to the ED; she was confused and unresponsive, with signs and symptoms suggesting viral encephalitis. After a workup including lumbar puncture fluid, she was treated empirically with i.v. acyclovir for viral encephalitis. Within one hour of receiving the acyclovir infusion, the patient developed angioedema of the lips, tongue, and periorbital areas requiring intubation and transfer to the intensive care unit. Further acyclovir therapy was withheld, and foscarnet therapy was initiated for the presumptive treatment of viral encephalitis. Over the next few days, the patient's angioedema completely resolved; her mental status gradually improved while she completed a 14-day course of foscarnet therapy. The application of the Naranjo scale indicated a probable adverse reaction to acyclovir, likely mediated by acyclovir-specific immunoglobulin E, highlighting the need to consider alternative antiviral agents without cross-reactivity to acyclovir in patients with confirmed or suspected viral encephalitis. CONCLUSION A 51-year-old woman with HIV infection developed probable acyclovir-induced angioedema after receiving i.v. acyclovir therapy for suspected viral encephalitis.
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Affiliation(s)
- Shin-Pung P Jen
- Pharmaceutical Care Division, The University Hospital, University of Medicine and Dentistry of New Jersey, Newark, USA.
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Bebarta VS, Morrissey R, Mirkin D. Antivenom Use for Copperhead Envenomations. J Am Coll Surg 2011; 213:692-3; author reply 693-4. [DOI: 10.1016/j.jamcollsurg.2011.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 08/18/2011] [Indexed: 10/15/2022]
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Floccard B, Crozon J, Rimmelé T, Vulliez A, Coppere B, Chamouard V, Boccon-Gibod I, Bouillet L, Allaouchiche B. Prise en charge en urgence de l’angiœdème à bradykinine. ACTA ACUST UNITED AC 2011; 30:578-88. [DOI: 10.1016/j.annfar.2011.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 01/25/2011] [Indexed: 11/30/2022]
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