[Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year]. / Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal.

BACKGROUND: In recent years, there has been an increase of drugs poisoning cases seen in the Emergency Department. This study has aimed to evaluate the characteristics of these cases in the Ramón and Cajal Hospital in Madrid. MATERIALS AND METHODS: A descriptive analysis about the drug poisonings diagnosed in 2004 was performed, using a retrospective search in the database of the electronic clinical records. The studied variables were gender, age, intention, drugs, admission into the hospital and relapse. RESULTS: There were 566 drug poisoning (47%) with a cumulative incidence of 0.1%, in which women (62.3%) were found to predominate, and the average patient age was 42.46+/-19.97 years (range 14-100 years). In 64.31% of the cases (566), only one kind of drug was used, benzodiazepine being the most common. This appeared at least once in 62% of the cases. Furthermore, 83% were cases of voluntary poisoning. Of the involuntary poisonings, digoxin was the most common drug with a frequency of 58.4%. A total of 28.6% of the cases were admitted into hospital, while the total number of patients who suffered a relapse in this period was 10%. DISCUSSION: Voluntary drug intoxications are caused mostly by psychoactive drugs, likely due to a high prevalence of underlying psychiatric disease in these patients. However, unintentional intoxications are mainly found in patients under chronic treatment with drugs such as digoxin and antiepileptics. More studies should be carried out to analyze which kind of preventive actions could reduce or avoid the high number of relapses.

Clomipramine test: serum level determination in three groups of psychiatric patients.

Concentrations of clomipramine, a specific and potent serotonin uptake inhibitor, are measured in 67 psychiatric patients and 12 normal volunteers. The psychiatric patients are grouped according to the DSM III R criteria namely; pathological gamblers, obsessive compulsives and sufferers of panic disorders. Before and 30, 60, 90 and 120 min after an intravenous infusion of the drug (12.5 mg in 10 min), serum samples are collected to evaluate the concentrations of cortisol, prolactine and growth hormone. Simultaneously the clomipramine concentration of these samples is determined and these results only are reported in this communication. Very different drug concentrations are observed in individual patients receiving the same amount of drug, indicating a substantial inter-individual variability of drug metabolism. No statistical differences (Newman-Keules test) between the clomipramine concentrations from the patients of the three psychiatric groups and the normal group are observed. Neither are statistical correlations observed when clomipramine concentrations from all individuals (n = 79) are related with the age, sex or consumer behaviour (cigarette smoking, alcohol and coffee intakes) of the patients.

[Clinical use of pharmacologic monitoring at a hospital community]. / Utilización clínica de la monitorización farmacológica en una comunidad hospitalaria.

This study reveals the efficiency of phenobarbital, diphenilhidantoine, carbamazepine, valproic acid and teophyline serum levels for their correct adjustment within the concentration gap considered optimal to produce the desired pharmacological effect. A total population of 882 patients treated with the drugs previously named is studied and an important improvement in dose adjustment is observed during these years as a consequence of drug's serum level knowledge.

Rapid gas-chromatographic microdetermination of soluphylline in serum.

A nitrogen-specific gas-chromatographic method is described for the quantitative analysis of soluphylline without the need for derivatization or evaporation of solvent, and using only 50 microliters of serum. The analysis is performed isothermally on a silicone stationary phase, 2% SP 2250 DA (Supelco). After a single neutral extraction with ethyl acetate containing the internal standard (beta-hydroxypropyl theophylline), an aliquot of the organic solvent is injected directly into the gas chromatograph. The detector sensitivity (least measurable amount) for soluphylline was 1 ng.

Can a single measurement of carbamazepine suffice for therapeutic monitoring?

Using fluorescence polarization immunoassay, we measured the peak and trough concentrations of total and free carbamazepine in serum and saliva from 33 epileptic children. We found that, except for patients who show side effects, measurement of trough values in a single sample, collected after an overnight fast and before the morning dose, sufficiently estimates clinical response. Moreover, total carbamazepine is as informative as free carbamazepine.

Determination of clobazam and its N-demethyl metabolite in serum of epileptic patients.

We describe a gas-liquid chromatographic method, using a nitrogen-specific detector, which is suitable for the simultaneous quantitation of clobazam and its main metabolite N-demethyl clobazam in the serum of epileptic patients treated with other anticonvulsant co-medication. Flunitrazepam (internal standard) is added to the sample and after extraction with a toluene/ethyl acetate mixture (3 + 1 by vol), the organic extract is evaporated and the residue is reconstituted in a small volume of solvent and chromatographed on a 3% SP2250 column. The sensitivity limits are about 2 to 5 micrograms per liter of original sample.