1
|
van Veelen A, Elias J, Postema PG, van de Veerdonk MC. A bizarre electrocardiogram with a fruitful recovery. Neth Heart J 2024; 32:264-266. [PMID: 38777986 PMCID: PMC11143163 DOI: 10.1007/s12471-024-01876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Anna van Veelen
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Joëlle Elias
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëlle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Buetler VA, Braunshausen AM, Weiler S, Klukowska-Rötzler J, Exadaktylos AK, Liakoni E. Characteristics of emergency department presentations following ingestion of Taxus baccata (yew). Clin Toxicol (Phila) 2023; 61:104-109. [PMID: 36594830 DOI: 10.1080/15563650.2022.2158097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Presentations of Taxus baccata (yew) poisoning can range between asymptomatic cases and life-threatening cardiotoxicity - depending on the amount ingested. This study aimed to describe emergency department (ED) presentations after yew exposure, and covers their clinical presentation, diagnostic and specific treatment, to contribute to optimising intreatment and prophylaxis. METHODS Retrospective observational study of cases (≥ 16 years of age) presenting at the ED of the University Hospital of Bern, Switzerland, from 1 May 2012 to 31 May 2020 following reported yew exposure. Cases were retrieved from the electronic patient database using full-text terms. RESULTS During the study period, 55 presentations (11 patients) of the 350,381 ED attendances were included. All patients were female and the median age on first presentation was 22 years (range 16-48). All 10 patients with intentional intake had previous diagnoses of psychiatric disorders. Commonly reported symptoms on presentation were gastrointestinal disturbances (31 presentations, 56%), neurological (six presentations, 11%) and subjective cardiovascular symptoms (five presentations, 9%). The most frequent clinical findings on presentation were tachycardia (15 presentations, 27%) and hypotension (11 presentations, 20%). In 52 presentations (95%), gastroscopic extraction of the leaves was performed, activated charcoal was administered in 25 cases (45%), and there were no fatalities. In the majority of the cases (40, 73%), the patient was admitted to psychiatric care and in 10 (18%) the patient was discharged home. CONCLUSION ED presentations after yew exposure appear to be rare, but potentially life-threatening and commonly observed in this study in young female patients with underlying psychiatric diseases. In this case series, gastroscopic extraction and activated charcoal application were commonly performed and there were no fatalities.
Collapse
Affiliation(s)
- Vanessa Alexandra Buetler
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Stefan Weiler
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Natural Taxanes: From Plant Composition to Human Pharmacology and Toxicity. Int J Mol Sci 2022; 23:ijms232415619. [PMID: 36555256 PMCID: PMC9779243 DOI: 10.3390/ijms232415619] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Biologically active taxanes, present in small- to medium-sized evergreen conifers of various Taxus species, are widely used for their antioxidant, antimicrobial and anti-inflammatory effects, but mostly for their antitumour effects used in the treatment of solid tumours of the breast, ovary, lung, bladder, prostate, oesophagus and melanoma. More of the substances found in Taxus plant extracts have medical potential. Therefore, at the beginning of this review, we describe the methods of isolation, identification and determination of taxanes in different plant parts. One of the most important taxanes is paclitaxel, for which we summarize the pharmacokinetic parameters of its different formulations. We also describe toxicological risks during clinical therapy such as hypersensitivity, neurotoxicity, gastrointestinal, cardiovascular, haematological, skin and renal toxicity and toxicity to the respiratory system. Since the effect of the drug-form PTX is enhanced by various Taxus spp. extracts, we summarize published clinical intoxications and all fatal poisonings for the Taxus baccata plant. This showed that, despite their significant use in anticancer treatment, attention should also be focused on the risk of fatal intoxication due to ingestion of extracts from these plants, which are commonly found in our surroundings.
Collapse
|
4
|
Ajouri J, Muellenbach RM, Rolfes CB, Weber K, Schuppert F, Peivandi AA, Reyher C. [Cardiogenic shock following yew needle poisoning : Digoxin immune fab, va-ECMO and albumin dialysis for the treatment of a suicidal yew leaf poisoning]. Anaesthesist 2021; 71:210-213. [PMID: 34608518 DOI: 10.1007/s00101-021-01048-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/30/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
We present the case of a 46-year-old male who developed refractory bradycardia with cardiogenic shock after attempting suicide by ingestion of yew leaves. Due to delayed availability of the Digoxin immune fab, a va-ECMO was established to maintain sufficient circulation. Administration of the digoxin fab resulted in recovery of spontaneous circulation. Continuous venovenous hemodiafiltration with hemoadsorption and albumin dialysis were initiated with the intention to remove immune fab-toxin complexes and as organ support in acute kidney and liver failure. Within 5 days the patient was successfully weaned from ECMO, liver support and renal replacement and discharged without physical sequelae.
Collapse
Affiliation(s)
- Jonas Ajouri
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland.
| | - R M Muellenbach
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland
| | - C B Rolfes
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland
| | - K Weber
- Notfallzentrum Nordhessen, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Deutschland
| | - F Schuppert
- Medizinische Klinik I, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Deutschland
| | - A A Peivandi
- Klinik für Herzchirurgie, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Deutschland
| | - C Reyher
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland
| |
Collapse
|
5
|
Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil's Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO. Infect Dis Rep 2021; 13:619-626. [PMID: 34287302 PMCID: PMC8293114 DOI: 10.3390/idr13030058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023] Open
Abstract
Leptospirosis is a zoonosis caused by infection with pathogenic strains of the bacterium Leptospira. The disease can be complicated by pulmonary hemorrhages and acute respiratory distress syndrome, with the mortality rate increasing to 51–100%. We report the case of a 37-year-old man who was admitted to the emergency department with a 6-day history of fever, weakness, vomiting and diarrhea, followed by jaundice. On admission, he presented leukocytosis, thrombocytopenia and acute liver and kidney injuries. His clinical course was critical, as it was immediately complicated by sepsis and severe respiratory failure, requiring haemodialysis, mechanical ventilation and broad-spectrum antibiotic therapy. In the following days, a veno-venous extracorporeal membrane oxygenation (VV-ECMO) was started due to a dramatic deterioration in respiratory function; 20 h later, it was switched to veno-arterial ECMO because of refractory cardiogenic shock. Hantavirus or Leptospira infection etiology was suspected, so penicillin G and methylprednisolone were initiated as an empirical therapy and subsequently confirmed after a laboratory diagnosis of leptospirosis. Although the clinical course was further complicated by hemorrhagic pneumonia, a gradual, full recovery occurred, and the patient was discharged from the hospital. After excluding other sources of contact with Leptospira-infected material, an unsuspected abnormal eating behavior was identified as the most probable cause of the patient’s Leptospira infection.
Collapse
|
6
|
Du EY, Nellore A, Pfeifer C, Norfleet G, Scalzo A, Riley SB. Dying to be with yew. TOXICOLOGY COMMUNICATIONS 2021. [DOI: 10.1080/24734306.2021.1918898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Eric Y. Du
- Department of Medicine, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Aditya Nellore
- Department of Medicine, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Courtney Pfeifer
- Forensic Toxicology Laboratory, St. Louis County Department of Health, St. Louis, MO, USA
| | - Gershom Norfleet
- St. Louis County Medical Examiner’s Office, St. Louis County Department of Health, St. Louis, MO, USA
| | - Anthony Scalzo
- Department of Internal Medicine, Medical Toxicology, Division of Emergency Medicine, Department of Surgery, Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Sarah B. Riley
- Department of Pathology, St. Louis University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
7
|
Alarfaj M, Goswami A. Cardiotoxicity in yew berry poisoning. Am J Emerg Med 2021; 50:812.e1-812.e4. [PMID: 34049761 DOI: 10.1016/j.ajem.2021.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022] Open
Abstract
Yew plants (Taxus species) represent a genus of plants known to be highly toxic, though lethal intoxication is rare. The majority of deaths in yew berry poisonings occur due to its cardiotoxic effect, mediated through generation of a number of fatal tachy- and brady-arrhythmias. However, there are no guidelines on the most effective management in these cases, and interventions vary greatly between published reports. Here we report a case of a 20-year-old female who presented with refractory lethal arrythmia and shock refractory to conventional therapy. She presented to the emergency department and promptly required airway management and hemodynamic support necessitating intensive care unit management. She received many antiarrhythmics, digoxin immune Fab, lipid emulsification, and eventually transvenous pacemaker insertion for overdrive pacing. Despite our interventions, our patient ultimately died after a decision to withdraw care. We also reviewed 43 reports of yew poisoning cases described in the literature. We discuss the most common strategies used to treat such patients including gastric decontamination, antiarrhythmics, electrical pacing, extracorporeal life support and other therapies. We need better understanding of this condition, to identify which therapies offer maximal benefit and to optimize outcomes for this rare but often devastating toxidrome.
Collapse
Affiliation(s)
| | - Ankur Goswami
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
8
|
Wei S, Niu MT, Dores GM. Adverse Events Associated with Use of Digoxin Immune Fab Reported to the US Food and Drug Administration Adverse Event Reporting System, 1986-2019. Drugs Real World Outcomes 2021; 8:253-262. [PMID: 33721285 PMCID: PMC8128941 DOI: 10.1007/s40801-021-00242-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background Digoxin immune fab products, DigiBind and DigiFab, are antidotes for the treatment of patients with life-threatening or potentially life-threatening digoxin toxicity or overdose. Although approved by the US Food and Drug Administration (FDA) in 1986 (DigiBind) and 2001 (DigiFab), there remains a paucity of literature describing the safety of these products in the postmarketing setting. Objective We sought to assess US adverse event (AE) reports submitted to the FDA Adverse Event Reporting System (FAERS) for DigiBind and DigiFab in the postmarketing period. Patients and Methods We searched reports for DigiBind and DigiFab submitted from the time of each product approval through December 31, 2019. Descriptive statistics were used to assess AE reports for DigiBind and DigiFab. Empirical Bayes geometric means (EBGMs) and their 90% confidence intervals were computed to identify disproportionate (i.e., at least twice the expected) reporting of DigiBind and DigiFab. Reports describing selected AEs and death outcomes were individually reviewed. Results A total of 78 DigiBind and 43 DigiFab reports were identified, of which 68 DigiBind (87.2%) and 27 DigiFab (62.8%) reports were serious. Among the most frequently reported AEs for both products [DigiBind, DigiFab, respectively] were cardiac (bradycardia [3.8%, 3.9%], cardiac arrest [3.3%, 3.9%], and hypotension [2.4%, 2.6%]) and non-cardiac (nausea [1.9%, 2.6%] and hyperkalemia [1.4%, 1.9%]) events. These AEs were labeled events or confounded by indication for use (digoxin toxicity). Nineteen (24.4%) DigiBind and 13 (30.2%) DigiFab reports described an outcome of death, of which seven (53.8%) DigiFab reports were attributed to poisoning with non-digoxin cardiac glycosides. No deaths could be attributed to DigiBind or DigiFab administration. Conclusions Our analysis did not identify new safety concerns for DigiBind or DigiFab. Most AEs reported were labeled events or confounded by indication for use.
Collapse
Affiliation(s)
- Shaokui Wei
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Manette T Niu
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Graça M Dores
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| |
Collapse
|
9
|
Hermes-Laufer J, Meyer M, Rudiger A, Henze J, Enselmann K, Kupferschmidt H, Müller D, Herzog A, Bettex D, Keller DI, Krüger B, Engeler J. Extracorporeal life support as bridge to recovery in yew poisoning: case reports and literature review. ESC Heart Fail 2020; 8:705-709. [PMID: 33232574 PMCID: PMC7835583 DOI: 10.1002/ehf2.12828] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 12/21/2022] Open
Abstract
Aims This short communication aims to review the treatment of cardiogenic shock in patients with yew poisoning based on two case reports from our institution, focusing on the use of extracorporeal life support (ECLS). Methods and results We report two cases of Taxus baccata poisoning treated with ECLS at our institution and review the literature based on a search in PubMed and Google Scholar on the topic of yew poisoning and ECLS. All cases were combined for analysis of demographics, ECLS therapy, and outcome. Case 1: A 35‐year‐old woman developed polymorphic ventricular tachycardia followed by cardiovascular arrest 5 h after orally ingesting a handful of yew needles. Successful resuscitation required ECLS for 72 h due to ongoing cardiac arrhythmias and cardiogenic shock. The patient left the hospital without neurological sequelae after 10 days. Case 2: A 30‐year‐old woman developed refractory cardiac arrhythmias and circulatory arrest. Resuscitation included ECLS for 71 h. T. baccata needles found by gastroscopy confirmed the diagnosis. The patient had no neurologic deficits and was transferred to psychiatry after 11 days. Review of the literature: Nine case reports were found and analysed along with our two cases. Five out of the 11 (45%) patients were female. Median (range) age was 28 (19–46) years. T. baccata needles were ingested with a suicidal intention in all patients. Median (range) duration of ECLS was 70 h (24–120 h). Eight (73%) patients had full neurological recovery. Conclusions Yew poisoning is a differential diagnosis in young psychiatric patients presenting with polymorphic ventricular tachycardia and cardiogenic shock. A characteristic cardiac contraction pattern in echocardiography may present a diagnostic clue. The early use of ECLS is a valuable bridge to recovery in most of these patients.
Collapse
Affiliation(s)
- Julia Hermes-Laufer
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Martin Meyer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alain Rudiger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Julian Henze
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Kai Enselmann
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Hugo Kupferschmidt
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland
| | - Daniel Müller
- Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Aline Herzog
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Bernard Krüger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Judith Engeler
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|