RESUMO
Serious exposure to the herbicide paraquat usually results in death, either due to gastrointestinal caustic lesions, shock, and acute respiratory distress syndrome or related to the progressive development of pulmonary fibrosis associated with refractory hypoxemia. We report a case of suicidal paraquat ingestion in a 59-year-old man. Most of the indicators of poor prognosis were encountered in this patient. Treatment consisted of early digestive decontamination and hemodialysis, followed by antioxidant therapy, including the administration of deferoxamine (100 mg/kg in 24 h) and a continuous infusion of acetylcysteine (300 mg/kg/d during 3 weeks). The patient only developed a nonoliguric acute renal failure, a mild alteration of liver tests, and an impairment of CO transfer factor without any respiratory complaint. Renal and hepatic disturbances completely resolved within 1 month, whereas CO transfer factor remained altered 14 months later. This observation suggests that early administration of an antioxidant therapy, including deferoxamine and acetylcysteine could be usefully associated with measures that prevent digestive absorption or enhance elimination to limit systemic toxicity in potentially fatal paraquat poisoning.
Assuntos
Paraquat/intoxicação , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação/diagnóstico , Intoxicação/terapia , Prognóstico , Tentativa de SuicídioRESUMO
Two very similar cases of drug-induced pneumonitis complicating treatment of rheumatoid arthritis with low-dose methotrexate are presented. Diagnosis was suggested by clinical history and findings, but the bronchoalveolar lavage showed a high percentage of neutrophils, an unusual feature in methotrexate-induced pneumonitis. Transbronchial lung biopsies (TBB) confirmed the diagnosis by showing interstitial lymphocytic infiltrate with microgranulomas. Although histologic findings are not strictly pathognomonic, when a differential diagnosis has to be made with infectious and rheumatoid lung disease, TBB appears to be of great promise.
Assuntos
Artrite Reumatoide/complicações , Líquido da Lavagem Broncoalveolar/citologia , Doenças Pulmonares Intersticiais/induzido quimicamente , Pulmão/patologia , Metotrexato/efeitos adversos , Idoso , Artrite Reumatoide/tratamento farmacológico , Biópsia , Broncoscopia , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Metotrexato/administração & dosagem , RadiografiaRESUMO
Sulmazol (AR-L 115BS), a phenylimidazopyridine derivative, which combines positive inotropic and vasodilating properties, was administered to nine patients who had a low cardiac output state (cardiac index below 2.0 L/min/m2) within 24 hours after cardiac surgery for valvular replacement (eight patients) or septal repair after myocardial infarction (one patient). Sulmazol, administered as a 60-minute infusion of 1.8 mg/min, resulted in significant increases in cardiac output and cardiac work, associated with significant decreases in cardiac filling pressures. Arterial pressure did not change notably, and systemic vascular resistance decreased significantly. A small but significant increase in heart rate was also observed. By its combined inotropic and vasodilating properties, sulmazol can be helpful in the management of low-output states after cardiac surgery.
Assuntos
Baixo Débito Cardíaco/tratamento farmacológico , Procedimentos Cirúrgicos Cardíacos , Cardiotônicos/administração & dosagem , Imidazóis/administração & dosagem , Idoso , Valva Aórtica/cirurgia , Cardiotônicos/farmacologia , Feminino , Septos Cardíacos/cirurgia , Hemodinâmica/efeitos dos fármacos , Humanos , Imidazóis/farmacologia , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Fatores de TempoRESUMO
A 44-year-old man developed severe permeability pulmonary edema associated with septic shock after near-drowning. Colloid osmotic pressure (COP) of deep tracheal fluid was persistently higher than plasma COP. Tracheal/plasma COP ratio reached a peak value of 1.75. A massive colloid infusion of 5% protein solution was incriminated in the development of this markedly elevated COP in the tracheal fluid.
Assuntos
Afogamento , Exsudatos e Transudatos/fisiologia , Edema Pulmonar/fisiopatologia , Traqueia/metabolismo , Adulto , Permeabilidade Capilar , Coloides , Humanos , Masculino , Pressão Osmótica , Edema Pulmonar/sangue , Edema Pulmonar/etiologia , Insuficiência Respiratória/etiologia , Ressuscitação , Choque Séptico/etiologiaRESUMO
Zolpidem, a recently developed sleep inducer, and prothipendyl, a neuroleptic azaphenothiazine, were involved in a voluntary intoxication along with ethanol. After administration of flumazenil, a specific benzodiazepines antagonist, respiratory depression was corrected. HPLC with UV detection methods after selective extraction were developed to measure simultaneously prothipendyl and zolpidem without flumazenil interaction. These methods could be applied in drug monitoring and in emergency toxicology.
Assuntos
Antipsicóticos/sangue , Hipnóticos e Sedativos/sangue , Piridinas/sangue , Tiazinas/sangue , Antipsicóticos/intoxicação , Cromatografia Líquida de Alta Pressão , Flumazenil/análise , Humanos , Hipnóticos e Sedativos/intoxicação , Naloxona/sangue , Piridinas/intoxicação , Tiazinas/intoxicação , ZolpidemRESUMO
In methanol intoxication, increased levels of the metabolite formate are associated with metabolic acidosis and an increased risk for ocular and neurological dysfunction. A simple method for plasma formate measurement by adaptation of a manual enzymatic assay to a Cobas Mira S analyzer is presented. Six microliters of sample is incubated for 5 min with buffer containing nicotinamide-adenine dinucleotide. Fifteen microliters of a suspension of formate dehydrogenase is then added. Absorbance at 340 nm is measured every 25 s. The NADH produced when formate is oxidized is stoichiometric to the amount of formate. The method is sensitive, reproducible, and specific and has a broad measurement range. The frozen reagents are stable for at least six months, so the described method can be applied to irregular and semi-urgent requests. A recent case is reported.
Assuntos
Formiato Desidrogenases/metabolismo , Formiatos/sangue , Metanol/metabolismo , Acidose/diagnóstico , Acidose/metabolismo , Adulto , Humanos , Indicadores e Reagentes , Masculino , Metanol/toxicidade , NAD/metabolismo , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Flumazenil acts as an antidote for pharmacological and toxic effects due to benzodiazepines. Several isolated observations and short uncontrolled series have also suggested a possible effect against the impairment of consciousness induced by pure alcohol intoxication. Patients admitted in the emergency department with coma related to acute alcohol (ALC) or pure benzodiazepine (BZD) intoxication were randomized and treated blindly with either placebo or 1 mg flumazenil. A modified Glasgow score was used to observe the evolution of consciousness. In the 18 ALC patients, 1 mg flumazenil was not more effective than placebo, whereas it appeared to be very active in the BZD group. However, an open administration of higher doses of flumazenil (2-5 mg) in 11 ALC patients, whose condition had not initially improved, was followed by clear improvement of consciousness in five of them. Flumazenil, administered at a dose usually active against BZD sedation, does not improve CNS depression induced by ALC intoxication. Higher doses could be more effective in some patients, but it should also be verified in a placebo-controlled trial.
Assuntos
Intoxicação Alcoólica/tratamento farmacológico , Flumazenil/uso terapêutico , Adolescente , Adulto , Idoso , Intoxicação Alcoólica/complicações , Benzodiazepinas/intoxicação , Coma/tratamento farmacológico , Coma/etiologia , Método Duplo-Cego , Overdose de Drogas/tratamento farmacológico , Emergências , Etanol/sangue , Feminino , Escala de Coma de Glasgow , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-IdadeRESUMO
The ability of high doses of flumazenil to antagonize ethanol-induced sedation was assessed via ethanol-induced loss of the righting reflex (LRR) in rats. Ethanol (3.5-5 g kg-1 i.p) produces a dose-dependent increase in the proportion of animals presenting a LRR response. Flumazenil (0.1 to 1 mg kg-1 i.p) was ineffective in preventing the suppression of the righting reflex and even aggravated it for ethanol dosages of 3.5 and 4.0 g kg-1. These data support the view that flumazenil has no effective 'anti-ethanol' properties. Conversely, the prolongation of mean sleep time provoked by the antidote could be related to the suppression of a putative endogenous inverse-agonist activity at the benzodiazepine receptor, which could be implicated in the mechanism of the acute tolerance to ethanol.
Assuntos
Intoxicação Alcoólica/psicologia , Flumazenil/farmacologia , Animais , Relação Dose-Resposta a Droga , Masculino , Equilíbrio Postural/efeitos dos fármacos , Ratos , Ratos Wistar , Reflexo/efeitos dos fármacos , Sono/efeitos dos fármacosRESUMO
Acute urticaria represents the most commonly observed skin disorder (35%) presenting in an emergency department. We retrospectively analysed the records of 676 patients admitted for acute urticaria in order to know the particularities and the main aetiologies. The mean age was 28; females being more affected than males. Aetiologies varied according to age; drugs were involved in 50% of patients more than 50-years old and in only 19% of children less than 10 years old. Whilst causes are rarely known in the chronic forms, almost 60% of the acute cases were due to drugs or food. Amongst the former, antibiotics and NSAI were the most frequently met.
Assuntos
Urticária/epidemiologia , Urticária/etiologia , Adolescente , Adulto , Distribuição por Idade , Bélgica/epidemiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Urticária/fisiopatologiaRESUMO
Zolpidem is a recently introduced sleep-inducer which is thought to act on the central-type benzodiazepine receptors. This observation is the first report of drug poisoning with this compound. The toxic response was characterized by the development of a profound but short-lasting coma, associated with pin-point pupils and respiratory depression, as observed in a narcotic overdose. These clinical signs were not influenced by the administration of naloxone, but responded dramatically to flumazenil. Some analytical data on zolpidem toxicokinetics are presented.
Assuntos
Flumazenil/uso terapêutico , Hipnóticos e Sedativos/intoxicação , Entorpecentes/intoxicação , Piridinas/intoxicação , Adulto , Antídotos/uso terapêutico , Coma/induzido quimicamente , Coma/fisiopatologia , Etanol/sangue , Humanos , Masculino , ZolpidemRESUMO
During the years 1986 to 1990, an increasing number of cases of acute carbon monoxide (CO) poisoning were encountered in the Emergency Department Hacettepe University Hospital in Ankara, Turkey. Between January 1 and March 31, 1991, all the patients presenting with complaints compatible with CO poisoning were evaluated; the diagnosis was confirmed in 55 of the 5795 people who attended the Emergency Department during this period. In all cases the source of CO intoxication was determined. Among these patients, nausea or vomiting and headaches were the most common complaints (occurring in 100% and 85%, respectively). At least transient impairment of alertness was observed in 29% of cases. The carboxyhaemoglobin levels ranged from 3.80 to 48.1% (median 14.2%). Two comatose patients who developed a non-cardiogenic pulmonary oedema required mechanical ventilation. One of them was discharged from the hospital with mild cerebral disability. Another patient developed an acute myocardial infarction. In all the cases in this series, the source of CO poisoning was identified as improper combustion of recently marketed steam coal in inadequately ventilated bucket stoves.
Assuntos
Intoxicação por Monóxido de Carbono/epidemiologia , Surtos de Doenças , Calefação/efeitos adversos , Acidentes Domésticos , Adolescente , Adulto , Idoso , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/etiologia , Criança , Pré-Escolar , Carvão Mineral/efeitos adversos , Qualidade de Produtos para o Consumidor , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Calefação/instrumentação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologiaRESUMO
A study was undertaken to assess the availability and use of non-invasive ventilation (NIV) for the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) in emergency departments in Belgium. A questionnaire was sent to the head physicians of 145 emergency departments (EDs) found in the list of the Belgian College of Emergency Physicians (BeCEP). Ninety eight questionnaires were analysed (representing 68% of the questionnaires sent). NIV was used in 49% of the EDs. In the hospitals where NIV was not used, the most important reasons given were no available equipment in 71%, lack of experience with this form of treatment in 32.7%, and more time consuming for physicians and nursing staff in 22.8%. Only 3.8% of the physicians doubted the benefit of NIV treatment. In the hospitals where NIV was used, the patient was watched during the first hour by one nurse only in 19.6%, by one physician in 8.6% and by a nurse and a physician in 54.5%. NIV was used for more than 4 h in 33% of EDs. Pressure-controlled ventilation (with home respirators) was used more often than volume-controlled ventilation.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Atitude do Pessoal de Saúde , Bélgica , Equipamentos e Provisões Hospitalares , Humanos , Inquéritos e QuestionáriosRESUMO
Medical data in the ED can only be approached with computers. A simple, easy and cheap system is described.
Assuntos
Computadores , Prontuários Médicos , Microcomputadores , Ambulatório Hospitalar/organização & administração , Bélgica , Sistemas de Gerenciamento de Base de Dados , HumanosRESUMO
The authors analyze the contribution of flumazenil to the diagnosis and the management of common drug poisoning. This paper defines the guidelines and limits for its use, after a review of the literature and the personal experience on this topic.
Assuntos
Benzodiazepinas/intoxicação , Flumazenil/farmacologia , Benzodiazepinas/antagonistas & inibidores , Flumazenil/administração & dosagem , Flumazenil/uso terapêutico , HumanosRESUMO
After a brief history of Emergency Departments in Belgium, the evolution of the clinical activity and the main research topics developed in Erasme Hospital are developed, including the management of the department and of patients flows, and acute clinical toxicology.
Assuntos
Serviço Hospitalar de Emergência , Bélgica , Pesquisa Biomédica , Hospitais Universitários , HumanosRESUMO
The serotonin syndrome is a hyperserotoninergic state resulting from an excess of intrasynaptic 5-hydroxytryptamine, induced by multiple psychotropic agents, but also non psychiatric drugs. It is a potentially dangerous and sometimes lethal condition. The clinical manifestations usually include cognitive, neuromuscular and autonomic features and are mediated by the action of serotonin on various subtypes of receptors. The main differential diagnosis is the neuroleptic malignant syndrome. Treatment is mainly supportive. No pharmacological agent has been definitely demonstrated really effective. However, reports of cases treated with the 5-HT2 blockers, including cyproheptadine or chlorpromazine have suggested that these agents could have some efficacy. Serotonin syndrome is a toxic condition which requires heightened clinical awareness among physicians in order to prevent, recognize, and treat the condition promptly.
Assuntos
Síndrome da Serotonina/diagnóstico , Síndrome da Serotonina/terapia , Diagnóstico Diferencial , Interações Medicamentosas , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Receptores de Serotonina/classificação , Receptores de Serotonina/efeitos dos fármacos , Fatores de Risco , Serotoninérgicos/efeitos adversos , Serotoninérgicos/classificação , Síndrome da Serotonina/induzido quimicamente , Síndrome da Serotonina/epidemiologiaRESUMO
Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated 'shock room' situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. In this article we describe our experiences using this shock room by detailing the demographic data, including time and source of admission, diagnosis and outcome, for the 2514 patients admitted to the shock room in 2006. The most common reasons for admission were cardiac (33%) and neurological (21%) diagnoses. After diagnosis and initial treatment, 54% of patients were transferred to an intensive care unit or a coronary care unit; 2.5% of patients died in the shock room. The shock room provides a useful area of collaboration between emergency department and intensive care unit staff and enables acutely ill patients to be assessed and treated rapidly to optimise outcomes.