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Vahabzadeh M, Eshraghi A, Akbari-Rad M, Firoozi A, Esmaeili A, Ahrari Y. Electrocardiographic Changes Following Acute Hydralazine Overdose. Arch Iran Med 2019; 22:53-56. [PMID: 30821162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
Hydralazine is an FDA-approved antihypertensive agent which has been utilized for years either alone or in combination with other medications especially the beta-blockers. Hydralazine works as a direct-acting vasodilator, thereby exerting a decrease in vascular resistance and increase in intravascular volume. When overdosed, hydralazine applies its toxic effects by extending its pharmacological action, which produces hypotension, syncope, tachycardia, and nausea. However, studies and case reports of acute hydralazine toxicity and its effects on electrocardiographic changes are rare, and most of the medical literature have only highlighted its immunological side effects. In this report, we are presenting a case of acute hydralazine overdose in a young woman who ended up in CCU due to remarkably abnormal electrocardiogram and unstable hemodynamics followed by myocardial infarction.
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Affiliation(s)
- Maryam Vahabzadeh
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Eshraghi
- Cardiology Department of Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mina Akbari-Rad
- Department of Internal Medicine, Gheam Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Alireza Esmaeili
- Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yaghoub Ahrari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
Lisinopril is not recommended for use by young children. This study attempted to identify factors associated with serious outcomes in pediatric lisinopril ingestions. Cases for this study were lisinopril ingestions by children age ≤5 years reported to Texas poison control centers during 1998- 2005. The percentage of cases involving serious medical outcomes was identified for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 691 total cases, 26 (3.8%) involved a serious outcome. Higher serious outcome rates were found with a max imum dose of >4 mg/kg (RR: 2.54, CI: 0.05-25.62), or > 80 mg (RR: 7.85; CI: 1.73-29.29),or five or more tablets (RR: 8.18; CI: 2.73-22.54), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR: 13.93; CI: 3.68-77.78),or referred to a health care facility by the poison control center (RR: 33.49; CI: 9.04-194.94). The management of patients with severe outcomes was more likely to involve health care facilities. This information is useful for drafting triage guidelines for the management of pediatric lisinopril ingestions. Human & Experimental Toxicology (2007) 26 , 83- 89
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Affiliation(s)
- M B Forrester
- Texas Department of State Health Services, 1100 W 49th Street, Austin, TX 78756, USA.
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Abstract
The objective of this study is to define the etiological and demographical characteristics of the patients applying to the emergency department in Faculty of Medicine, Çukurova University because of poisoning. This retrospective study was carried out by examining the records of 491 people who applied to the main emergency department in Faculty of Medicine, Cukurova University, with the complaint of poisoning between January 1, 2004 and December 31, 2004. It was determined that the reason why 491 of 20 817 persons (2.4%) applied during this term was because of poisoning: 159 (32.4%) of such patients were male and 332 of them (67.6%) were female. It was found that the average age of men was 27.1 ± 10.5 years and that of women was 24.4 ± 9.5 years ( P = 0.005); 427 of poisoning cases (87.0%) happened intentionally as suicide attempts and 64 of them (13.0%) were accidental. The rate of suicide-purposed poisoning was higher in women and the rate of unintentional poisoning was higher in men ( P ± 0.001). The drugs were accountable for 71.1% of all poisoning cases and the pesticides were accountable for 18.9% of such cases. Poisonings increase during summers. The mortality rate in poisonings was found as 0.8%. The drugs and pesticides in Ckurova region constitute 90.0% of all poisoning cases. The mortality rate in poisoning will be decreased by training the physicians employed in the emergency department about poisoning by drugs and pesticides. Human & Experimental Toxicology ( 2007) 26, 401—406
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Affiliation(s)
- M Akbaba
- Department of Public Health, Medical Faculty, Cukurova University, Adana, Turkey.
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Cibickova L, Caran T, Dobias M, Ondra P, Vorisek V, Cibicek N. Multi-drug intoxication fatality involving atorvastatin: A case report. Forensic Sci Int 2015; 257:e26-e31. [PMID: 26508377 DOI: 10.1016/j.forsciint.2015.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 11/13/2022]
Abstract
Mixed antihypertensive drug intoxication poses a significant risk for patient mortality. In tandem to antihypertensives, hypolipidemic medicines (especially statins) are often prescribed. Among their well-known adverse effects belongs rhabdomyolysis. We report a case of fatal multi-drug overdose in a 65-year-old female alcoholic. The patient was unconscious at admission. Empty blister packs indicated the abuse of 250 tablets of urapidil, 42 tablets of verapamil/trandolapril, 50 tablets of moxonidin, 80 tablets of atorvastatin and 80 tablets of diacerein. Standard measures (gastric lavage, activated charcoal, mechanical ventilation, massive doses of vasopressors, volume expansion, diuretics and alkalinization) failed to provide sufficient drug elimination and hemodynamic support and the sufferer deceased on the fourth day. Dramatic elevations of serum myoglobin (34,020 μg/L) and creatine kinase (219 μkat/L) were accompanied by rise in cardiac troponin I and creatinine. Gas chromatography revealed ethanol 1.17 g/kg (blood) and 2.81 g/kg (urine). Thin layer chromatography and gas chromatography of gastric content and urine verified verapamil, moxonidin and urapidil fragment (diacerein method was unavailable). Atorvastatin and trandolapril concentrations (LC-MS(n)) equaled 277.7 μg/L and 57.5 μg/L, resp. (serum) and 8.15 μg/L and 602.3 μg/L, resp. (urine). Histology confirmed precipitates of myoglobin with acute necrosis of proximal renal tubules in association with striated muscle rhabdomyolysis and myocardial dystrophy. Cardiogenic-distributive shock in conjunction with acute renal failure due to the combined self-poisoning with vasoactive agents and atorvastatin were determined to be this decedent's immediate cause of death. The manner of death was assigned to be suicidal.
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Affiliation(s)
- Lubica Cibickova
- 3(rd) Department of Internal Medicine-Nephrology, Rheumatology and Endocrinology, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic
| | - Tomas Caran
- Department of Anesthesiology and Resuscitation, Hospital Hranice, Zborovská 1245, 753 22 Hranice, Czech Republic
| | - Martin Dobias
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Hněvotínská 3, 775 09 Olomouc, Czech Republic
| | - Peter Ondra
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Hněvotínská 3, 775 09 Olomouc, Czech Republic
| | - Viktor Vorisek
- Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Norbert Cibicek
- Department of Medical Chemistry and Biochemistry, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic.
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Lauterbach M. Response to Cantrell and Villano. J Emerg Med 2015; 49:63. [PMID: 25910828 DOI: 10.1016/j.jemermed.2015.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/11/2015] [Indexed: 06/04/2023]
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Cantrell FL, Villano J. Comments on: "Toxicity of Antihypertensives in Unintentional Poisoning of Young Children". J Emerg Med 2015; 49:63. [PMID: 25858340 DOI: 10.1016/j.jemermed.2014.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Affiliation(s)
- F Lee Cantrell
- California Poison Control System, San Diego Division, San Diego, CA
| | - Janna Villano
- California Poison Control System, San Diego Division, San Diego, CA
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Nasa P, Singh A, Juneja D, Singh O, Javeri Y. Continuous venovenous hemodiafiltration along with charcoal hemoperfusion for the management of life-threatening lercanidipine and amlodipine overdose. Saudi J Kidney Dis Transpl 2014; 25:1255-8. [PMID: 25394445 DOI: 10.4103/1319-2442.144262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The management includes fluid resuscitation, calcium gluconate, glucagon, vasopressors, and high-dose insulin-euglycemia therapy. We describe a rare case of massive overdose of lercanidipine with shock, refractory to conventional therapies and multi-organ failure. Charcoal hemoperfusion with continuous venovenous hemodiafiltration was then used successfully and the patient showed remarkable recovery.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, Max Superspeciality Hospital, New Delhi, India
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Abstract
BACKGROUND Intralipid emulsion (ILE) is a nutritional fatty acid supplementation that is emerging as a potential therapy for local anesthetic systemic toxicity and is also being considered as a therapy for other lipophilic medication intoxications. Isolated reports of pulmonary edema or severe lipemia exist as a complication of therapy. CASE REPORT A 26-year-old hypertensive, male, kidney transplant recipient presented to an outside emergency department (ED) after an intentional overdose of his medications (ie, amlodipine, metoprolol, lisinopril). At presentation, he had hypotension and bradycardia that was unresponsive to treatment with intravenous saline, calcium, glucagon, and vasopressors. After failure of conventional therapy, an initial bolus of ILE (20%) was given with some improvement in his heart rate, and the dose was repeated. A continuous intravenous infusion of ILE therapy was started. The patient deteriorated, with development of both acute respiratory and renal failure. Continuous venovenous hemofiltration (CVVHF) was attempted to remove volume and correct metabolic abnormalities. Lipemic blood was immediately observed in the CVVHF filter. After 15 min, the transmembrane pressures of the filter began to rise in the absence of observed clotting of the blood and the filter then became completely obstructed. An attempt was made to remove the lipid by plasmapheresis to restart CVVHF, but the patient continued to deteriorate despite maximal vasopressor support. The patient's family decided to withdraw care and the patient expired. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians treat patients with toxic ingestions on a regular basis. Being aware of possible complications of experimental antidote therapy, like ILE, can improve the treatment approach and outcomes for these patients.
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Affiliation(s)
- Betzaida Rodríguez
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew Wilhelm
- Division of Pulmonary and Critical Care, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kenneth E Kokko
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
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Abstract
BACKGROUND Antihypertensive medications, including β-blockers, are widely used in patients with chronic kidney disease. Unlike most β-blockers, atenolol is excreted primarily by the kidney, and its clearance by peritoneal dialysis is poor. These pharmacokinetic factors may predispose patients to gradual accumulation of the drug over time. OBJECTIVES To review the management of a diagnostic dilemma, the role of glucagon therapy, and the clinical implications of atenolol clearance. CASE REPORT A young woman with end-stage renal disease requiring peritoneal dialysis presented with sudden onset of abdominal pain and hemodynamic instability with hypotension and relative bradycardia. The patient reported that she took her regular four antihypertensive agents, including atenolol, with no excess ingestion or recent dose changes. After resuscitation and consideration of a broad differential diagnosis, the most likely cause of the patient's illness was determined to be unintentional atenolol toxicity, with secondary mesenteric ischemia due to a low-flow state that caused her abdominal pain. Glucagon therapy led to rapid correction of the patient's hemodynamic instability and pain. CONCLUSION The unique pharmacokinetics of long-term medications must be considered in patients with impaired clearance, such as this patient with end-stage renal disease treated by peritoneal dialysis. Medications may gradually accumulate to supratherapeutic levels, which over time may lead to symptoms of significant toxicity.
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Affiliation(s)
- Nathan R Hoot
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Noordally SO, Sohawon S, Duttmann R, Gottignies P, Devriendt J. Tongue necrosis as a complication of vasoconstrictor agents in the intensive care setting. Intern Emerg Med 2011; 6:183-5. [PMID: 20535588 DOI: 10.1007/s11739-010-0416-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
Affiliation(s)
- S Oaleed Noordally
- Intensive Care Unit, Department of Critical Care, CHU Brugmann, Free University of Brussels, 4, Place A. Van Gehuchten, 1020, Brussels, Belgium.
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Sorodoc V, Sorodoc L, Lionte C, Gazzi E, Jaba IM, Mungiu OC. [Intentional poisoning with ACE inhibitors. Emergeny Hospital Iaşi]. Rev Med Chir Soc Med Nat Iasi 2010; 114:359-362. [PMID: 20700967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Regarding angiotensin-converting enzyme inhibitors (ACEI) poisoning, only few data are available in the last decade literature. In the previous couple of years especially isolated case reports were published. MATERIAL AND METHOD We analyzed retrospectively all the patients with acute ACEI poisoning admitted in Iaşi Internal Medicine and Toxicology Clinic between 2004 and 2009. RESULTS 17 cases of poisoning were recorded (enalapril-9 cases, captopril-3 cases, perindopril-3 cases, lisinopril-2 cases). All the poisonings were intentional. A favorable outcome was consistently observed, and were recorded no sequelae or death in this study. The main complain was hypotension, required fluid administration, only one case with 500 mg enalaprilum and severe hypotension required injection of vasopressive amines. No abnormal renal function and no angioedema were noted.
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Affiliation(s)
- Victoriţa Sorodoc
- Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi Facultatea de Medicină, Spitalul Clinic de Urgenţe Sf. Ioan Iaşi, Clinica de Medicină Internă şi Toxicologie Facultatea de Medicină
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Vroman R. Pediatric toxicology: Part 2. What EMS providers need to know about "one-pill killers". EMS Mag 2008; 37:88-92. [PMID: 18814676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Robert Vroman
- Paramedic Education Program, HealthONE EMS, Englewood, CO, USA
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Affiliation(s)
- Alysha Behrman
- Cincinnati Drug and Poison Information Center, Cincinnati, Ohio 45219, USA.
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Abstract
There is limited information on potentially adverse lisinopril ingestions reported to poison control centers. Using adult lisinopril ingestions reported to Texas poison control centers during 1998—2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 468 cases identified, 43 (9%) involved serious outcomes. The severity of the outcome associated with adult lisinopril ingestions depended on the dose and the circumstances of the ingestion. Thus, serious outcomes were significantly more likely to occur with a maximum dose >80 mg (RR 5.69, CI 2.43—13.33) or, if the dose was unknown, ≥3 tablets (RR 9.57, CI 2.39—54.97), where the circumstances of the exposures involved self-harm or malicious intent (RR 6.96, CI 3.65—13.31), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR 7.33, CI 3.09—17.85) or referred to a health care facility by the poison control center (RR 23.76, CI 10.62—55.67). The management of patients with severe outcomes was more likely to involve health care facilities. Such information is useful for creating of triage guidelines for the management of adult lisinopril ingestions. Human & Experimental Toxicology (2007) 26, 483—489
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Affiliation(s)
- Mathias B Forrester
- Texas Department of State Health Services, 1100 W 49th Street, Austin, TX 78756, USA.
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Abstract
We report the case of a 46-yr-old male who developed severe lactic acidosis, cardiorespiratory arrest, and rhabdomyolysis following an overdose of metformin and ramipril. The lactic acidosis was successfully treated with early high-volume continuous veno-venous haemofiltration. Rhabdomyolysis and lower limb compartment syndrome developed later. The patient otherwise made a good recovery. We discuss the management of severe lactic acidosis secondary to metformin overdose and the association with rhabdomyolysis.
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Affiliation(s)
- M Galea
- Department of Anaesthesia and Intensive Care, St Peter's Hospital, Guildford Road, Chertsey KT16 0PZ, UK.
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Fiszer M, Kołaciński Z, Rechciński T. [The application of 4-aminopyridine in calcium channel inhibitors acute poisoning]. Przegl Lek 2007; 64:293-7. [PMID: 17724889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Calcium channel inhibitors have been extensively used to treat arterial hypertension, ischaemic heart disease and supraventricular rhythm irregularities. The poisonings by that category of drugs are extremely dangerous, particularly when accompanied by intoxication with other drugs affecting the circulatory function. This paper reports 3 cases of poisonings with calcium channel inhibitors (verapamil and diltiazem) in combination with angiotensin convertase inhibitors and nonselective beta-adrenolytics. Circulatory insufficiency and cardiac rhythm abnormalities were noted in all reported cases, in one in the form of ventricular bigeminy and two episodes of ventricular fibrillation, while in the two other cases in the form of 1 degree atrioventricular block. The persisting hypotonia combined with heart rhythm disturbances could not be prevented by the typical conservative treatment involving intravenous administration of infusion fluids, calcium formulations, catecholamines and atropin. The application of 4-amino-pyridine (Pymadin) caused that arterial tension and heart rate were higher, and the heart rhythm disturbances disappeared. The reported cases suggest a beneficial effect of 4-aminopyridine used to treat cases of poisonings by calcium channel inhibitors; however, up to the present time, no detailed procedures have been determined for 4-aminopyridine administration in cases like those reported above. 4-aminopyridine has not been included in the list of the antidotes approved by the WHO and, therefore, broader tests and more clinical observations are required to confirm its therapeutic value.
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Affiliation(s)
- Marta Fiszer
- Klinika Ostrych Zatruć, Instytut Medycyny Pracy.
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Hasin T, Leibowitz D, Antopolsky M, Chajek-Shaul T. The Use of Low-Dose Insulin in Cardiogenic Shock due to Combined Overdose of Verapamil, Enalapril and Metoprolol. Cardiology 2006; 106:233-6. [PMID: 16685130 DOI: 10.1159/000093191] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 03/11/2006] [Indexed: 11/19/2022]
Abstract
We describe a case of severe heart failure due to the combined effect of verapamil and enalapril overdose in a patient treated regularly with metoprolol. The patient was dependent for 2 days on glucagon and dopamine infusion but remained oliguric, with deteriorating renal function. Marked improvement in all hemodynamic parameters was noted a short time after initiation of treatment with low-dose insulin infusion (1-2 units/h), which allowed the prompt withdrawal of glucagon and dopamine. We discuss the efficacy of glucose-insulin treatment in toxic cardiac depression and suggest that a low dose may be beneficial in similar cases.
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Affiliation(s)
- Tal Hasin
- Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Abstract
An epiletic patient, suffering from partial complex seizures and hypertension, ingested approximately 42 g of oxcarbazepine (OXC) and an undefined number of tablets containing an association of benazepril and hydrochlorothiazide along with some glasses of wine. Four hours later he was brought to the emergency room. He was stuporous and gradually became unconscious. Therefore he was intubated and, approximately 6 hours after the overdose, transferred to the intensive care unit, where he underwent a 4-hour hemodialysis. Even if this procedure did not accelerate the elimination of the prodrug nor its active metabolite (monohydrocarbazepine), 3 hours after the end of dialysis the patient was fully recovered.
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Affiliation(s)
- Mario Furlanut
- Department of Pharmacology, Institute of Clinical Pharmacology and Toxicology, DPMSC, University of Udine, Udine, Italy.
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Abstract
Grayanotoxin intoxication, which is mostly seen in the eastern Black Sea region of Turkey, stems from the "mad honey" made by bees from the rhododendron plant flowers. In low doses, this causes dizziness, hypotension, and bradycardia, and in high doses, impaired consciousness, seizures, and atrioventricular block (AVB). This case study was designed as a series of cases of patients (6 women, 2 men) aged between 35 and 75 years. All of the patients' physical examinations revealed hypotension; 4 patients had sinus bradycardia, 3 had nodal rhythm, and 1 had complete AVB. In all patients, except for the patient with AVB, heart rate and blood pressure returned to normal limits within 2 to 6 hours. Two patients were monitored in the coronary intensive care unit. Of these 2, 1 was discharged on the second day. The other was fitted with a temporary pacemaker and was discharged on the third day. All the other patients were kept in for a 6-hour observation period and were then discharged from the ED. To date, 58 such cases have been reported, but we saw 8 patients within 2005. It is commonly seen in the east of the Black Sea region, although cases may occur from all over the eastern Black Sea region of Turkey. So far, no cases of death have been reported, although grayanotoxin causes adverse effects on the cardiovascular and respiratory systems and is therefore of considerable importance.
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Affiliation(s)
- Abdulkadir Gunduz
- Department of Emergency Medicine, Karadeniz Technical University Faculty of Medicine, 61080 Trabzon, Turkey.
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Abstract
Two fatal overdoses of the calcium channel blocker amlodipine are described. Postmortem samples were screened for volatiles and therapeutic and abused drugs. Amlodipine was measured by liquid chromatography-atmospheric pressure photoionization-mass spectrometry. The heart blood amlodipine concentrations for the two cases were 2.4 and 0.95 mg/L, and amlodipine was quantified in all other tissues. In the first case, venlafaxine and norvenlafaxine were also found, and the angiotensin receptor antagonist olmesartan was tentatively identified. The concentrations of amlodipine are compared with previously reported fatal and nonfatal overdoses. The medical examiners ruled in both cases that the manner of death was suicide and the causes of death were mixed drug intoxication and amlodipine intoxication.
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Affiliation(s)
- Jason H Sklerov
- Division of Forensic Toxicology, Office of the Armed Forces Medical Examiner, 1413 Research Blvd., Rockville, Maryland 20850, USA.
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Abstract
More than 97% of pediatric exposures reported to the AAPCC in 2001 had either no effect or mild clinical effects. Despite the large number of exposures, only 26 of the 1074 reported fatalities occurred in children younger than age 6. These findings reflect the fact that, in contrast to adolescent or adult ingestions, pediatric ingestions are unintentional events secondary to development of exploration behaviors and the tendency to place objects in the mouth. Ingested substances typically are nontoxic or ingested in such small quantities that toxicity would not be expected. As a result, it commonly is believed that ingestion of one or two tablets by a toddler is a benign act and not expected to produce any consequential toxicity. Select agents have the potential to produce profound toxicity and death, however, despite the ingestion of only one or two tablets or sips. Although proven antidotes are a valuable resource, their value is diminished if risk after ingestion is not adequately appreciated and assessed. Future research into low-dose, high-risk exposures should be directed toward further clarification of risk, improvements in overall management strategies,and, perhaps most importantly, prevention of toxic exposure through parental education and appropriate safety legislation.
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Affiliation(s)
- Joshua B Michael
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Kumbasar B, Atlibatur Akbas F, Serez K, Ger E, Uzunoglu S, Ergen K, Ayer M. High-dose exposure to valsartan with suicidal intention. Int J Clin Pharmacol Ther 2004; 42:328-9. [PMID: 15222725 DOI: 10.5414/cpp42328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Valsartan is a strong angiotensin receptor inhibitor specific for the angiotensin I receptor, which has been proven safe and well-tolerated in clinical trials. We were able to confirm its safety and tolerability in a case of high-dose exposure to valsartan with suicidal intention. A 25-year-old, fully conscious, female patient was brought to our hospital by relatives on July 24, 2001, at 9:15 p.m. following intake of a high dose of valsartan. It was established that she had taken 28 Diovan 80 mg tablets (2.24 g) 5 hours before admission to the hospital. Her clinical condition at the time of admission was good and did not deteriorate after admission. During the follow-up, her blood pressure never fell below 90/60 mmHg. The only complaint she had were painful muscle cramps which, with only supportive therapy, disappeared spontaneously over 2 days, and her blood pressure also returned to normal during this period. This report demonstrates the effect/side effect profile of valsartan when taken at a high dose, not achievable in a clinical trial.
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Affiliation(s)
- B Kumbasar
- 3rd Internal Medicine Clinic, Haseki Hospital, Istanbul, Turkey
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Abstract
We determined tissue distribution of diltiazem after it was used to treat hypertension in two cases. The postmortem interval was 16 h in both cases. Diltiazem was isolated using liquid-liquid extraction, and it was identified and quantitated using gas chromatography-mass spectrometry (GC-MS) and GC, respectively. In one case, diltiazem concentrations in the lungs and pulmonary vessel blood were 62-82 and 27-30 times higher than right femoral blood, respectively. Although blood was not obtained from the left cardiac chambers, aortic blood showed a 10-times higher level of diltiazem than right femoral venous blood. Diltiazem concentration in blood in the right cardiac chambers was 3.6 times higher than that in right femoral venous blood. In another case, diltiazem concentrations in the lungs were 7.4-7.6 times higher than right femoral venous blood. Blood in the pulmonary arteries, pulmonary veins, left cardiac chambers, and aorta showed 2.0-3.1 times higher levels of diltiazem than right femoral venous blood. Blood in the right cardiac chambers displayed only 1.3 times higher level of diltiazem than right femoral venous blood. Our results strongly suggest that diltiazem accumulated in the lungs and was rapidly redistributed into pulmonary venous blood and then into the left cardiac chambers.
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Affiliation(s)
- Fumio Moriya
- Department of Legal Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan
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25
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Abstract
Losartan is a specific angiotensin II receptor antagonist. Although the teratogenic effects of angiotensin converting enzyme (ACE) inhibitors are well documented there are limited reports of losartan induced fetal toxicity. The authors report a case of incomplete ossification of skull bones, transient oliguria and feed intolerance in a newborn following in-utero exposure to losartan.
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Affiliation(s)
- Bonilla Nayar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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26
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Chodorowski Z, Anand JS, Waldman W. [Suicidal poisoning with antihypertensive drugs]. Przegl Lek 2003; 60:233-5. [PMID: 14569890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In the period from 1990 to 2002, 201 patients with suicidal antihypertensive drugs poisoning were treated, including 138 women and 63 men from 15 to 84 (mean 36) years old. The main causes of suicides were various kinds of depression (63%) as well as psychopathy and/or sociopathy (16%) and schizophrenia (10%). Twenty eight patients attempted repeatedly to commit suicide. Thirty six persons were poisoned by only antihypertensive drugs, in 165 remaining cases intoxications were mixed including antihypertensive and other different medications. beta-blockers (38.3%), calcium channel blockers (34.8%), angiotensin converting enzyme inhibitors (24.3%) and diuretics (2.5%) were used in suicidal attempts. There were no suicidal poisonings with angiotensin II AT1 receptor antagonists, alpha 1-blockers and imidazole receptor agonists. In the examined group three patients died of cardiogenic shock, electromechanical dissociation and secondary acute respiratory failure resistant to therapy. The drugs used in these cases were propranolol, amlodipine, theophylline, captopril, doxepine, propafenone, furosemide, methimazole and alcohol. Mortality rate in antihypertensive drug poisonings was 1.5%.
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Affiliation(s)
- Zygmunt Chodorowski
- I Klinika Chorób Wewnetrznych i Ostrych Zatruć Akademii Medycznej w Gdańsku, 80-211 Gdańsk, ul. Debinki 7
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27
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Ballesteros García MM, Fernández Carrión F, Casanueva Mateos L, Sánchez Díaz JI, Gómez de Quero P, Ramos Casado V, Mar Molinero F. [Nitroprusside poisoning]. An Pediatr (Barc) 2003; 58:81-2. [PMID: 12628129 DOI: 10.1016/s1695-4033(03)78001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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28
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Szpak D, Groszek B, Piotrowski W, Scisłowski M. [Severe mixed poisoning with diltiazem, potassium and magnesium: a case report]. Przegl Lek 2003; 60:257-61. [PMID: 14569897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
We report the case of 52-year-old woman, who ingested 3.6 g of diltiazem, 16 g of potassium chloride and 6.5 g of magnesium, in a suicide attempt 4 hours before admission. She developed cardiorespiratory failure, with severe hypotonia and acute renal failure, in ECG third degree atrioventricular block was stated. The highest potassium concentration was 8.0 mmol/l, magnesium 2.15 mmol/l. As a result of multiple pharmacologic intervention, including intravenous fluids, calcium, glucagon, dopamine, dobutamine, norepinephrine, transvenous pacing and peritoneal dialysis (haemodynamic instability makes haemodialysis noneffective) the haemodynamic stabilization of cardiovascular system and normalization of potassium and magnesium concentration were achieved. The diltiazem concentration was measured using liquid chromatography, the result was 0.89 microgram/ml. She was discharged in a good clinical condition on day 26th.
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Affiliation(s)
- Dorota Szpak
- Klinika Toksykologii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie, 31-826 Kraków, Os. Złotej Jesieni 1
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29
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Wnek W. [The use of intra-aortic balloon counterpulsation in the treatment of severe hemodynamic instability from myocardial depressant drug overdose]. Przegl Lek 2003; 60:274-6. [PMID: 14569902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
A case of refractory hemodynamic instability following metoprolol and diltiazem overdose is reported. Management included intra-aortic balloon counterpulsation as an adjunct to pharmacologic therapy in cardiogenic shock from overdose of myocardial depressant drugs.
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Affiliation(s)
- Włodzimierz Wnek
- Oddział Anestezjologii i Intensywnej Terapii z Ośrodkiem Ostrych Zatruć Szpital Wojewódzki nr 2 w Rzeszowie, 35-301 Rzeszów, ul. Lwowska 60
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30
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Rucka E, Łata S. [Acute poisoning with cardiovascular drugs: data from Acute Poisoning Ward in Tarnów]. Przegl Lek 2003; 60:292-4. [PMID: 14569907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In this paper an analysis of poisonings with cardiovascular drugs treated in the II Ward of Internal Diseases and Acute Poisonings in Tarnów, in the years from 1996 to 2001, is presented. In 6 years 66 patients were treated (4.5% of all treated toxicological cases). The most frequent kind of drugs were antihypertensive drugs (44 cases), mainly beta-blockers--17 cases. No fatalities were observed. Suicidal poisoning with propafenone in 22-year-old man is presented.
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Affiliation(s)
- Elzbieta Rucka
- II Oddział Chorób Wewnetrznych i Ostrych Zatruć Szpital Wojewódzki im. św. Łukasza w Tarnowie, 33-100 Tarnów, ul. Lwowska 178 a
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31
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Abstract
BACKGROUND Metformin is prescribed with an increasing frequency for patients with Type II diabetes mellitus; the increasing availability increases the risk of intentional overdoses. Metformin may cause severe lactic acidosis in overdose, especially when accompanied by co-ingestants or other medical conditions that alter lactate handling or metformin elimination. Though the clearance of therapeutic metformin by hemodialysis is known, the clearance in the setting of a large overdose has not been reported. CASE REPORT A 58-year-old man with a history of Type II diabetes, hypertension, bipolar disease, and decreased renal function presented after ingestion of approximately 40 500-mg metformin tablets and 20 240-mg diltiazem sustained-release tablets. Clinical manifestations of poisoning included somnolence, hypotension, bradycardia, severe lactic acidosis, and ultimately death. Gastric decontamination was attempted with gastric lavage, multiple dose activated charcoal, and whole bowel irrigation. Hemodynamic support was provided with pressors, glucagon, insulin, and intra-aortic balloon pump. Due to hypotension, continuous renal replacement therapy, rather than hemodialysis, was initiated. Continuous veno-venous hemodialysis was performed with a blood flow of 180 mL/min and dialysate flow of 2.5 L/h. A Multiflow 60 kidney (Cobe) on a Prisma (Cobe) continuous renal replacement therapy machine was used. The initial metformin level was 110 microg/mL (therapeutic range 1-2 microg/mL). By continuous veno-venous hemodialysis, an absolute clearance of 50.4 mL/min was obtained. CONCLUSION Metformin was cleared by the continuous veno-venous hemodialysis modality of continuous renal replacement therapy in this metformin overdose. Although a fatal outcome occurred in this patient, its utility in other patients with metformin overdose should be investigated.
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Affiliation(s)
- Fermin Barrueto
- Department of Emergency Medicine, Brody Medical School at East Carolina University, Greenville, North Carolina 27858, USA
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32
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Abstract
A case of massive atenolol ingestion leading to hypotension in association with PR and QRS interval prolongation on the electrocardiogram is presented. These clinical findings are identical to those attributed to the membrane-stabilizing activity of propranolol and other lipophilic beta-blockers. It is commonly believed that hydrophilic agents such as atenolol lack this activity. A review of the literature reveals that hydrophilic beta-blockers may have membrane-stabilizing activity, though much higher concentrations are required to produce this action in comparison with lipophilic agents. This case and a review of the literature provides a potential pathophysiological basis for atenolol-induced haemodynamic depression.
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Affiliation(s)
- J N Love
- Department of Emergency Medicine, Georgetown University Hospital, 3800 Reservoir Rd, NW, Washington, DC 20007, USA
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33
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Abstract
Medication errors due to the exclusive use of trade names of drugs may lead to life-threatening complications. We report the case of a patient with verapamil overdose as a result of this. This case illustrates that the use of trade names, omitting the international nonproprietary names of the active moiety, carries the risk of serious adverse drug events by overdose.
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Affiliation(s)
- Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstrasse 112, D-70376 Stuttgart, Germany.
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34
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Froldi R, Cingolani M, Cacaci C. A case of suicide by ingestion of sodium nitroprusside. J Forensic Sci 2001; 46:1504-6. [PMID: 11714168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The study reports a case of suicide by ingestion of sodium nitroprusside which resulted in acute cyanide poisoning. Analyses carried out on body fluid yielded the quantitation of total (5.00 mg/L) and free (3.30 mg/L) cyanide in blood and of methemoglobin (blood = 10.5%). At the scene, some solid reddish-brown material was found in a glass, which on toxicological analysis was found to contain sodium nitroprusside; about 9 g of the same substance was identified in stomach contents. The detection and quantification of cyanide and methemoglobin in biological samples from the case indicated that the lethal effect was due to both metabolic products (cyanide and methemoglobin).
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Affiliation(s)
- R Froldi
- Institute of Legal Medicine, University of Macerata, Italy
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35
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Abstract
A 5-year-old child who weighed 17.5 kg received 50 mg of clonidine. The amount ingested was confirmed by analysis of the suspension administered (clonidine HCl 9.78 mg/mL). To our knowledge, this represents the largest ingestion in a child and the largest ingestion on a milligram per kilogram basis in the medical literature. The child's initial presentation included hyperventilation, an unusual feature of clonidine toxicity. The child was discharged without sequela 42 hours after admission. A serum concentration of clonidine 17 hours postingestion was 64 ng/mL, the highest reported to date in a pediatric patient. The intoxication was traced to a pharmacy compounding error in which milligrams were substituted for micrograms. Increased prescribing of clonidine in young children coupled with the requirement to compound clonidine in a suspension and the narrow therapeutic index suggests that the frequency of severe ingestions in children will increase in the future.
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Affiliation(s)
- M J Romano
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA.
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36
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Feldman R, Glińska-Serwin M. [Deep hypotension with transient oliguria and severe heart failure in course of acute intentional poisoning with amlodipine]. Pol Arch Med Wewn 2001; 105:495-9. [PMID: 11865580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
A case of acute poisoning with amlodipine with deep hypotension, transient oliguria and clinical signs of acute heart failure was described. A woman of 23 years swallowed intentionally 60 tablets of amlodipine (600 mg). After eleven hours of ingestion she was admitted to Warsaw Poison Control Centre. She was in severe clinical condition; tachycardia and deep hypotension were the prominent signs of poisoning. There was not CNS depression. Intensive treatment with i.v. catecholamines (dopamine, norepinephrine), crystalloids (with continuous control of central venous pressure), and i.v. calcium salts (with control of plasma calcium concentration) was started immediately. The patient did not improve but got worse. Acute heart failure developed, especially of left ventricle, so i.v. crystalloids were stopped and dubutamin, morphine, nitroglycerin and glucagon were introduced. Because of oliguria and insufficient effect of high doses of furosemide four-hours hemodiafiltration was set in. The patient's condition slowly improve after third and forth day of hospitalization. The systolic blood pressure rose, heart work was really better and on sixth day--the stabilization of diastolic blood pressure was definitely achieved. The patient was discharge in good condition with heart ejection fraction of 65% measured echocardiographically.
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Affiliation(s)
- R Feldman
- III Oddział Chorób Wewnetrznych, Stołeczny Ośrodek Ostrych Zatruć
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37
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Quispel R, Baur HJ. [Attempted suicide with sustained release diltiazem]. Ned Tijdschr Geneeskd 2001; 145:918-22. [PMID: 11387868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A 15-year-old woman was admitted to the intensive care unit after intentional auto-intoxication with 10 tablets of 200 mg diltiazem sustained release. She developed hypotension and became oliguric. This was followed by metabolic acidosis. Maximum plasma lactate concentration was 10 mmol/l and the highest measured plasma diltiazem level was 500 micrograms/l. The occurrence of pulmonary oedema due to adult respiratory distress syndrome (ARDS) was striking and the patient required mechanical ventilation for a period of three days as a result of this. After five days in the intensive care unit, she was transferred to a psychiatric hospital in a good physical condition. Sustained release diltiazem intoxications have previously been described on five occasions.
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Affiliation(s)
- R Quispel
- Medisch Centrum Haaglanden, locative Westeinde, afd. Intensive Care, Den Haag
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38
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Abstract
We report a case of maternal exposure to the antihypertensive drug losartan during weeks 20-31 of pregnancy. We saw the fetal toxic effects of oligohydramnios (decreased amniotic fluid), fetal pulmonary hypoplasia, fetal hypoplastic skull bones, and subsequent fetal death. This pattern of abnormalities is similar to those seen in exposure to angiotensin-converting-enzyme (ACE) inhibitors during pregnancy, and were probably caused by losartan.
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39
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Gitter MF, Cox R. Clonidine toxicity in an adolescent patient. J Miss State Med Assoc 2000; 41:757-9. [PMID: 11037697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Clonidine is a central acting a2-agonist used primarily as an antihypertensive agent. Recently, it has been used for the treatment of attention deficit hyperactivity disorder in children and adolescents. When taken in excess, it can produce profound CNS depression, apnea, bradycardia and hypotension. A transient period of hypertension can sometimes occur. Treatment is primarily supportive, including respiratory support, atropine for bradycardia, and fluids and dopamine for hypotension. The CNS depression sometimes responds to naloxone. Young children are very sensitive to the toxic effects of clonidine. A case of an 11 year old adolescent who took an overdose of his clonidine is described to illustrate the toxicity of this agent.
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Affiliation(s)
- M F Gitter
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA
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40
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Abstract
CASE REPORT An East-European prostitute in Amsterdam robbed several victims, after having sedated them with clonidine solution (available as plastic ampoules of eyedrops) added to her victims' drinks. One victim was hospitalized. His symptoms included bradycardia, hypotension, hypothermia, pallor, cyanosis, and impaired consciousness. Treatment included isoprenaline for 28 hours. The victim was released from hospital the next day. In court, the female offender confessed and was sentenced to prison for 3 1/2 years. She may have administered doses as high as 8 mg clonidine.
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Affiliation(s)
- K J Lusthof
- Department of Toxicology, Forensic Sciences Institute, Rijswijk, The Netherlands.
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41
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NY: failure to 'understand'--Pt. overdoses: do your pts. 'understand' you? Are you sure? Nurs Law Regan Rep 2000; 41:3. [PMID: 11995104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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42
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Abstract
A case of acute intoxication with propranolol is reported. A 60-year-old man was found dead in his car with no evidence of trauma or signs of asphyxia. Near the car, a pharmaceutical box of Inderal, a pharmaceutical formulation containing propranolol, was found. The man was not under therapy with this medication, but circumstantial data suggested the use of this medicine by his sister. High blood levels of propranolol confirmed the suspected drug use and induced us to discuss the probable lethal mechanism of this substance. The analysis of this compound was performed by liquid-liquid extraction followed by gas chromatography/mass spectrometry determination.
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Affiliation(s)
- N Fucci
- Istituto di Medicina Legale e delle Assicurazioni, Universita Cattolica del Sacro Cuore, Rome, Italy
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43
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Affiliation(s)
- V Bara
- National Poisons Information Service London
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44
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Nasfi A. [Drug poisoning in the aged]. Soins Gerontol 1999:22-4. [PMID: 10735004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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45
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Bruce-Keller AJ, Geddes JW, Knapp PE, McFall RW, Keller JN, Holtsberg FW, Parthasarathy S, Steiner SM, Mattson MP. Anti-death properties of TNF against metabolic poisoning: mitochondrial stabilization by MnSOD. J Neuroimmunol 1999; 93:53-71. [PMID: 10378869 DOI: 10.1016/s0165-5728(98)00190-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The cytokine tumor necrosis factor (TNF) is toxic to some mitotic cells, but protects cultured neurons from a variety of insults by mechanisms that are unclear. Pretreatment of neurons or astrocytes with TNF caused significant increases in MnSOD activity, and also significantly attenuated 3-nitropropionic acid (3-NP) induced superoxide accumulation and loss of mitochondrial transmembrane potential. In oligodendrocytes, however, MnSOD activity was not increased, and 3-NP toxicity was unaffected by TNF. Genetically engineered PC6 cells that overexpress MnSOD also were resistant to 3-NP-induced damage. TNF pretreatment and MnSOD overexpression prevented 3-NP induced apoptosis, and shifted the mode of death from necrosis to apoptosis in response to high levels of 3-NP. Mitochondria isolated from either MnSOD overexpressing PC6 cells or TNF-treated neurons maintained resistance to 3-NP-induced loss of transmembrane potential and calcium homeostasis, and showed attenuated release of caspase activators. Overall, these results indicate that MnSOD activity directly stabilizes mitochondrial transmembrane potential and calcium buffering ability, thereby increasing the threshold for lethal injury. Additional studies showed that levels of oxidative stress and striatal lesion size following 3-NP administration in vivo are increased in mice lacking TNF receptors.
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Affiliation(s)
- A J Bruce-Keller
- Sanders-Brown Research Center on Aging, Department of Anatomy and Neurobiology, University of Kentucky, Lexington 40536-0230, USA.
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46
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Luzhnikov EA, Gol'dfarb IS, Il'iashenko KK, Matkevich VA, Savina AS, Sukhodolova GN, Arkhapchev IP. [Clinical manifestation, diagnosis and treatment of rare forms of acute drug poisoning (lecture)]. TERAPEVT ARKH 1998; 70:65-8. [PMID: 9864808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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47
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Karnawat BS, Chowdhry BR. Clonidine overdose. Indian Pediatr 1998; 35:1119-21. [PMID: 10216550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- B S Karnawat
- Department of Pediatrics, J.L.N. Medical College, Ajmer, India
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48
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Abstract
The patient was discharged approximately 36 hours after admission to the emergency department. At that time she was awake and alert and responding appropriately to her surroundings. Her vital signs were within normal limits. It took approximately 2 weeks to receive the baby's clonidine level, which was 11.0 ng/mL; the therapeutic level is between 0.5 to 4.5 ng/mL. We came to the conclusion that the babysitter's clonidine patch had accidentally fallen into the playpen, where the baby subsequently sucked on it. To this day, the babysitter denies any involvement. Situations such as this confront emergency nurses every day, and questions arise regarding intent. In this case, the physician interviewed the babysitter and believed that the overdose was unintentional. Once again we are reminded of the fragility of life, the importance of capable, cautious caregivers, and just how easily accidents can happen. What a happy outcome this turned out to be after what appeared to be such a grave medical emergency on presentation!
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Affiliation(s)
- M E Kraft
- Kaiser Permanente, Vallejo, Calif., USA
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49
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Abstract
This is the first report to describe the delayed onset of hypoglycemia in a child after ingestion of one tablet of glipizide. A 2-year-old boy was observed to ingest 5 mg glipizide and 25 mg hydrochlorothiazide. Activated charcoal was administered within 35 minutes of ingestion. Hypoglycemia (serum glucose 49 mg/dL) developed 11 hours later. Emergency physicians must be aware of the potential for delayed hypoglycemia in children with single-tablet ingestions of glipizide. Prolonged monitoring of glucose levels is warranted.
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Affiliation(s)
- C S Szlatenyi
- Division of Emergency Medicine, Brown University School of Medicine, Providence, RI, USA
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50
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Abstract
Electromechanical dissociation (EMD) occurred in a 20-year-old woman 48 hours after an overdose of atenolol, despite intensive treatment of the beta-blocker poisoning (gastric lavage, charcoal, glucagon, epinephrine, atropine, correction of electrolyte abnormalities, administration of fluids, cardiac pacing, and mechanical ventilation). Administration of calcium chloride during EMD repeatedly restored blood pressure. Therefore it may have a role to play in management of atenolol overdose.
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Affiliation(s)
- F Pertoldi
- Intensive Care Unit, General Hospital, Pordenone, Italy
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