Legal Highs, Lethal Lows.

Novel Psychoactive Substances (NPS), sometimes referred to as Legal Highs, are newly available drugs with psychoactive properties that are not currently prohibited by United Nations Drug Conventions. Despite many of these compounds still being 'legal' and readily available via online mail-order companies and high-street 'headshops', their rapid emergence in the UK has been associated with increasing hospital admissions, enquiries on TOXBASE® and fatalities. It is therefore vital that Acute Physicians have a good understanding of the issues in recognizing, investigating and managing patients presenting to the AMU with toxicity due to legal highs. This article outlines the classification and effects of various novel psychoactive substances and presents a strategy for management according to the prevailing toxidrome.

Problem-based review: calcium channel blocker (CCB) poisoning.

A 56-year-old female presents to the emergency department 6h after taking an overdose of verapamil MR 120 mg × 28 capsules. She has a past medical history of hypertension and atrial flutter. On admission her GCS is 15, HR 50/min, BP 100/64, Capillary blood glucose(CBG) 10.2. ECG shows sinus bradycardia with prolongation of the PR interval. You estimate her weight to be 60 kg.

Cardiac arrest following paracetamol overdose complicated by hypokalaemia.

We present a case of paracetamol overdose in a 34-year-old female with a history of depression and alcoholism. Following treatment with N-acetylcysteine (Parvolex®) our patient developed ventricular tachycardia resulting in cardiac arrest from which she was successfully resuscitated. Subsequent ECG demonstrated prolongation of the QTc interval and repeat blood tests revealed a significant fall in serum potassium from 4.2mmol/l on admission to 2.2mmol/l. The possible mechanisms contributing to the development of hypokalaemia after overdose with paracetamol are discussed. The existing literature relating to paracetamol-induced hypokalaemia is briefly reviewed.

A case of postural orthostatic tachycardia syndrome on the acute medical unit.

We describe a case of postural orthostatic tachycardia syndrome (POTS) in a young female, presenting several weeks after neurosurgery, to the Medical Admissions Unit. The diagnosis is discussed with reference to differential diagnosis, diagnostic criteria, pathophysiology and treatment.

Tricyclic Antidepressant Overdose causing Acute Respiratory Distress Syndrome.

We report two recent cases of tricyclic antidepressant (TCA) overdose complicated by the development of acute respiratory distress syndrome (ARDS). The previous literature documenting an association between TCAs and ARDS is reviewed. We propose that the respiratory complications of TCA overdose should be more widely publicised and included in national toxicology databases.