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1.
Tidsskr Nor Laegeforen ; 144(6)2024 May 14.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-38747669

RESUMO

Background: A woman in her seventies presented to the accident and emergency department (A&E) with shortness of breath that had increased over a period of three weeks. She had a history of COPD, hypertension and polymyalgia rheumatica. A medication error involving methotrexate, used for autoimmune diseases, was discovered during her medical history review. Case presentation: The patient arrived with stable vital signs, including 94 % oxygen saturation and a respiratory rate of 20 breaths/min. She had been taking 2.5 mg of methotrexate daily for the past three weeks instead of the prescribed weekly dose of 15 mg. Other examinations revealed no alarming findings, except for a slightly elevated D-dimer level. Interpretation: Considering her medical history and exclusion of other differential diagnoses, methotrexate toxicity was suspected. The patient was admitted to the hospital and intravenous folinic acid was initiated as an antidote treatment. Five days later, the patient was discharged with an improvement in the shortness of breath. This case underscores the importance of effective communication in health care, particularly in complex cases like this, where understanding dosages and administration is crucial. Medical history, clinical examinations and medication reviews, often involving clinical pharmacists, are vital in the A&E to reveal medication errors.


Assuntos
Erros de Medicação , Metotrexato , Humanos , Feminino , Metotrexato/efeitos adversos , Metotrexato/administração & dosagem , Idoso , Dispneia/induzido quimicamente , Leucovorina/efeitos adversos , Leucovorina/administração & dosagem , Antídotos/administração & dosagem , Antídotos/uso terapêutico , Antirreumáticos/efeitos adversos , Antirreumáticos/administração & dosagem
2.
J Med Case Rep ; 17(1): 554, 2023 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-38129927

RESUMO

BACKGROUND: We report a case of a clinical challenge lasting for 12 months, with severe and unresolved clinical features involving several medical disciplines. CASE PRESENTATION: A 53-year-old Caucasian male, who had been previously healthy apart from a moderate renal impairment, was hospitalized 12 times during a 1-year period for a recurrent complex of neurological, cardiovascular, and gastrointestinal symptoms and signs, without any apparent etiology. On two occasions, he suffered a cardiac arrest and was successfully resuscitated. Following the first cardiac arrest, a cardiac defibrillator was inserted. During the 12th admission to our hospital, aconitine poisoning was suspected after a comprehensive multidisciplinary evaluation and confirmed by serum and urine analyses. Later, aconitine was also detected in a hair segment, indicating exposure within the symptomatic period. After the diagnosis was made, no further episodes occurred. His cardiac defibrillator was later removed, and he returned to work. A former diagnosis of epilepsy was also abandoned. Criminal intent was suspected, and his wife was sentenced to 11 years in prison for attempted murder. To make standardized assessments of the probability for aconitine poisoning as the cause of the eleven prior admissions, an "aconitine score" was established. The score is based on neurological, cardiovascular, gastrointestinal, and other clinical features reported in the literature. We also make a case for the use of hair analysis to confirm suspected poisoning cases evaluated after the resolution of clinical features. CONCLUSION: This report illustrates the medical challenge raised by cases of covert poisoning. In patients presenting with symptoms and signs from several organ systems without apparent cause, poisoning should always be suspected. To solve such cases, insight into the effects of specific toxic agents is needed. We present an "aconitine score" that may be useful in cases of suspected aconitine poisoning.


Assuntos
Aconitina , Arritmias Cardíacas , Parada Cardíaca , Parestesia , Humanos , Masculino , Pessoa de Meia-Idade , Aconitina/intoxicação , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/terapia , Coração , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/terapia , População Branca
3.
Tidsskr Nor Laegeforen ; 142(1)2023 01 17.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-36655970

Assuntos
Riso , Humanos
4.
Basic Clin Pharmacol Toxicol ; 127(1): 47-51, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31977139

RESUMO

Paracetamol has a good safety profile, but pharmacogenetic differences in drug-metabolizing enzymes may have an impact on its risk of hepatotoxicity. We present a case of fatal acute liver failure (ALF) after therapeutic doses of paracetamol in a patient with Duchenne muscular dystrophy, where pharmacogenetic screening was conducted. This 30-year-old man was electively admitted for a tracheostomy. A total of 14.5 g paracetamol was given over four days. He developed a severe ALF and died 11 days after admission. Pharmacogenetic screening showed absent CYP2D6 metabolism and increased CYP1A2 activity, which may have increased the formation of toxic intermediate metabolite, N-acetyl-p-benzo-quinone imine (NAPQI). He also had decreased function of UGT2B15, which increases the amount of paracetamol available for metabolism to NAPQI. Having a reduced muscle mass and thus a reduced glutathione levels to detoxify produced NAPQI may add to the risk of toxicity. This case may indicate that pharmacogenetic variability is of potential relevance for the risk of paracetamol-induced hepatotoxicity in patients with neuromuscular diseases. Further studies should investigate if pharmacogenetic screening could be a tool to detect potentially increased risk of hepatotoxicity in these patients at therapeutic doses of paracetamol and hence provide information for selection of analgesic treatment.


Assuntos
Acetaminofen/efeitos adversos , Falência Hepática/induzido quimicamente , Distrofia Muscular de Duchenne , Testes Farmacogenômicos , Acetaminofen/metabolismo , Adulto , Benzoquinonas/análise , Doença Hepática Induzida por Substâncias e Drogas , Citocromo P-450 CYP1A2/metabolismo , Citocromo P-450 CYP2D6/metabolismo , Glucuronosiltransferase/metabolismo , Glutationa , Humanos , Iminas/análise , Fígado/efeitos dos fármacos , Fígado/metabolismo , Falência Hepática/metabolismo , Masculino
5.
Resuscitation ; 149: 170-179, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31926258

RESUMO

BACKGROUND: Outcome prediction after out-of-hospital cardiac arrest (OHCA) may lead to withdrawal of life-sustaining therapy if the prognosis is perceived negative. Single use of uncertain prognostic tools may lead to self-fulfilling prophecies and death. We evaluated prognostic tests, blinded to clinicians and without calls for hasty outcome prediction, in a prospective study. METHODS: Comatose, sedated TTM 33-treated OHCA patients of all causes were included. Clinical-neurological/-neurophysiological/-biochemical predictors were registered. Patients were dichotomized into good/poor outcome using cerebral performance category (CPC) six months and > four years post-arrest. Prognostic tools were evaluated using false positive rates (FPR). RESULTS: We included 259 patients; 49 % and 42 % had good outcome (CPC 1-2) after median six months and 5.1 years. Unwitnessed arrest, non-shockable rhythms, and no-bystander-CPR predicted poor outcome with FPR (CI) 0.05 (0.02-0.10), 0.13 (0.08-0.21), and 0.13 (0.07-0.20), respectively. Time to awakening was median 6 (0-25) days in good outcome patients. Among patients alive with sedation withdrawal >72 h, 49 % were unconscious, of whom 32 % still obtained good outcome. Only absence of pupillary light reflexes (PLR) -and N20-responses in somato-sensory evoked potentials (SSEP), as well as increased neuron-specific enolase (NSE) later than 24 h to >80 µg/L, had FPR 0. Malignant EEG (burst suppression/epileptic activity/flat) differentiated poor/good outcome with FPR 0.05 (0.01-0.15). CONCLUSION: Time to awakening was over six days in good outcome patients. Most clinical parameters had too high FPRs for prognostication, except for absent PLR and SSEP-responses >72 h after sedation withdrawal, and increased NSE later than 24 h to >80 µg/L.


Assuntos
Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Coma/etiologia , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Fosfopiruvato Hidratase , Prognóstico , Estudos Prospectivos
6.
Acta Anaesthesiol Scand ; 63(5): 630-638, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30623406

RESUMO

BACKGROUND: The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients. METHODS: Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason. RESULTS: Among 70 included patients, 79% were males and mean age was 62 (±12.1) years. All received thromboprophylaxis with dalteparin, and 44 (63%) used graduated compression stockings. VTE was found in 19 (27%) patients; deep vein thrombosis in 15 (21%) and pulmonary embolism in 4 (6%). Among the VTEs, 11 (58%) presented within the first 48 hours after admission, two (11%) were located in the lower limbs and five (26%) were symptomatic. Risk factors for VTE in multivariable analyses were malignancy, abdominal surgery and SAPS II score <41 with an AuROC (95% CI) of 0.72 (0.58-0.85, P = 0.01). Patients with and without VTE had comparable ICU LOS (13 vs 11 days, P = 0.27) and mortality (16% vs 20%, P = 0.72). CONCLUSION: Venous thromboembolism was observed in 27% of ICU patients receiving thromboprophylaxis. Factors associated with increased risk of VTE were malignancy, abdominal surgery and SAPS II score <41. Presence of VTE did not impact on patient outcome.


Assuntos
Estado Terminal , Tromboembolia Venosa/epidemiologia , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade , Trombose Venosa/epidemiologia
7.
Scand J Trauma Resusc Emerg Med ; 24: 76, 2016 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-27206472

RESUMO

BACKGROUND: Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC). METHODS: All patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry. RESULTS: There were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries. CONCLUSION: The procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.


Assuntos
Instituições de Assistência Ambulatorial , Serviços Médicos de Emergência/métodos , Pacientes Ambulatoriais , Intoxicação/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações , Doença Aguda , Adulto , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Intoxicação/epidemiologia , Intoxicação/etiologia , Estudos Prospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
8.
Clin Toxicol (Phila) ; 49(6): 478-84, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21824058

RESUMO

OBJECTIVE: Fomepizole is the antidote of choice in toxic alcohol poisonings. Potential side effects from frequent use of fomepizole were studied in a patient admitted 154 times with ethylene glycol (EG) poisoning. The intra-individual correlation between the serum-ethylene glycol (serum-EG) and the osmolal gap (OG) EG-kinetics, and other laboratory parameters were also studied. METHODS: Combined pro- and retrospective collection of material from three different hospitals, and results from autopsy. RESULTS: A 26-year-old female with a dissociative disorder was admitted with EG poisoning a total of 154 times. Her admission data revealed a median pH of 7.31 (range 6.87-7.49), pCO(2): 4.2 kPa (1.2-6.7) (32 mmHg [9-50]), HCO-3: 15 mmol/L (4-26) (15 mEq/L [4-26]), base deficit (BD): 10 mmol/L (- 4 to 27) (10 mEq/L [-4 to 27]), serum-creatinine 65 µmol/L (40-133) (0.74 mg/dL [0.45-1.51]), OG 81 mOsm/kgH(2)O (25-132), and serum-EG 44 mmol/L (4-112) (250 mg/dL [25-700]). She was treated with fomepizole 99 times, ethanol 60 times (with a combination of both six times), and dialysis 73 times. The correlation between serum-EG and OG was good (r(2) = 0.76). She was finally found dead outside hospital with an EG blood concentration of 81 mmol/L (506 mg/dL). An autopsy revealed calcium oxalate crystals in the kidneys, slight liver steatosis, and slight edema of the lungs. DISCUSSION: The frequent use of fomepizole in this young patient was not associated with any detectable side effects; neither on clinical examination and lab screening, nor on the later autopsy. Regarding the sequelae from the repetitive EG-poisoning episodes, her kidney function seemed to normalize after each overdose. She was treated with buffer and antidote without hemodialysis 81 times without complications, supporting the safety of this approach in selected cases.


Assuntos
Etilenoglicol/intoxicação , Adulto , Antídotos/uso terapêutico , Transtornos Dissociativos/complicações , Etilenoglicol/farmacocinética , Feminino , Fomepizol , Glicolatos/sangue , Meia-Vida , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/induzido quimicamente , Rim/metabolismo , Rim/patologia , Fígado/metabolismo , Fígado/patologia , Oxalatos/metabolismo , Intoxicação/diagnóstico , Intoxicação/patologia , Pirazóis/uso terapêutico , Recidiva , Diálise Renal , Suicídio
9.
BMC Psychiatry ; 8: 8, 2008 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-18271956

RESUMO

BACKGROUND: To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. METHODS: A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980), voluntary detoxification (n = 75, 1980/1981) or both (n = 17). Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs) were computed for mortality, in general, and in particular, for different causes of death. RESULTS: During a period of 20 years, 70 opioid addicts died (37.8%), with a standardized mortality ratio (SMR) equal to 23.6 (95% CI, 18.7-29.9). The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%), suicide (7.1%), cancer (4.3%), cardiovascular disease (2.9%), other violent deaths (2.9%), other diseases (71.4%). Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total). SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9-86.9). The SMR was 5.4 (95% CI, 1.3-21.5) for cardiovascular diseases, and 4.3 (95% CI, 1.4-13.5) for cancer. The SMR was 13.2 (95% CI, 6.6-26.4) for accidents, 10.7 (95% CI, 4.5-25.8) for suicides, and 28.6 (95% CI, 7.1-114.4) for other violent deaths. CONCLUSION: The risk of death among opioid addicts was significantly higher for all causes of death compared with the general population, implying a poor prognosis over a 20-year period for this young patient group.


Assuntos
Mortalidade Hospitalar/tendências , Drogas Ilícitas/intoxicação , Entorpecentes/intoxicação , Transtornos Relacionados ao Uso de Opioides/mortalidade , Acidentes/mortalidade , Adolescente , Adulto , Causas de Morte/tendências , Estudos de Coortes , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Computação Matemática , Neoplasias/mortalidade , Noruega , Transtornos Relacionados ao Uso de Opioides/reabilitação , Admissão do Paciente/estatística & dados numéricos , Risco , Suicídio/estatística & dados numéricos , Violência/estatística & dados numéricos
10.
Tidsskr Nor Laegeforen ; 126(13): 1731-3, 2006 Jun 22.
Artigo em Norueguês | MEDLINE | ID: mdl-16794664

RESUMO

BACKGROUND: Poisoning with paracetamol is common and potentially serious. We have assessed the incidence of paracetamol poisoning and the hospital's use of serum analyses to monitor the antidotal treatment N-acetyl cysteine. MATERIAL AND METHODS: All hospital records of ICD-10 diagnoses T4n and T50.9 at the Department of Acute Medicine from July 2001 to July 2004, were retrospectively reviewed. All cases with possible or confirmed paracetamol poisoning were recorded. Liver damage was defined as ALT above 1,000 U/l. Standard European treatment nomogram was used. RESULTS: Of 869 admissions with acute poisoning, 158 (21%) were caused by paracetamol; of these 120 (76%) were women and 38 (24%) were men. 107 (68%) of the patients were treated with N-acetyl cysteine at admission due to suspected ingestion of more than 10 grams of paracetamol. Treatment was abrupted in 84 (79%) of the patients, as levels of serum paracetamol were below the treatment line in the nomogram. The median time from admission to sampling was 5 hours. Nine patients (6%), who all arrived later than 15 hours after ingesting paracetamol, developed liver damage. One woman died after a sub-acute overdose of paracetamol. INTERPRETATION: Few patients needed treatment with antidote. The treatment seemed to protect all against liver damage if started early. Liver damage and death was associated with admission later than 15 hours after intake.


Assuntos
Acetaminofen/intoxicação , Analgésicos não Narcóticos/intoxicação , Acetaminofen/sangue , Acetilcisteína/administração & dosagem , Acetilcisteína/efeitos adversos , Adulto , Analgésicos não Narcóticos/sangue , Antídotos/administração & dosagem , Antídotos/efeitos adversos , Overdose de Drogas , Feminino , Humanos , Fígado/efeitos dos fármacos , Fígado/enzimologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Fatores de Tempo
11.
Tidsskr Nor Laegeforen ; 125(24): 3421-3, 2005 Dec 15.
Artigo em Norueguês | MEDLINE | ID: mdl-16357882

RESUMO

BACKGROUND: Lead poisoning is rare. Intake of lead shots may cause damage of the bone marrow, the nervous system, the liver, the kidneys and the endocrine organs. MATERIALS AND METHODS: We present two patients who had taken approximately 120 grams of lead shots. They developed asthenia, nausea and abdominal pain. We tried to remove the lead shots with fluids, laxatives and colonoscopy, but ultimately surgical intervention had to be performed. The patients were also treated with dimercaptosuccinic acid (DMSA). RESULTS AND INTERPRETATION: Although DMSA treatment is associated with a significant decrease in blood lead concentration and an increase of lead urinary excretion, surgical intervention is the most efficient way of treating oral intake of lead. Treatment with DMSA will probably have to go on for months in order to give an additional effect.


Assuntos
Corpos Estranhos , Intoxicação por Chumbo/etiologia , Adulto , Antídotos/administração & dosagem , Corpos Estranhos/cirurgia , Humanos , Intoxicação por Chumbo/tratamento farmacológico , Intoxicação por Chumbo/terapia , Masculino , Pessoa de Meia-Idade , Succímero/administração & dosagem
12.
Tidsskr Nor Laegeforen ; 125(6): 731-5, 2005 Mar 17.
Artigo em Norueguês | MEDLINE | ID: mdl-15776066

RESUMO

The threat from chemical warfare agents such as nerve agents against civilians has traditionally been considered irrelevant. Following the recent terrorist attacks in the US on 11 September 2001 and in Madrid, Spain on 11 March 2004, the threat from such weapons is taken seriously. Hospitals must therefore be prepared to take care of civilian victims. Emergency preparedness implies education and training of healthcare professionals, stocking of antidotes, and training of personnel. This involves decontamination of patients, establishment of routines to avoid contamination of hospitals, and the ability to determine if patients and first responders are contaminated with chemicals and to avoid such contamination. Treatment against nerve agents includes atropine, acetylcholinesterase reactivators (obidoxime or pralidoxime) and benzodiazepines (diazepam). Because these drugs are not sufficiently effective in protecting the brain, new and more effective countermeasures must be developed.


Assuntos
Substâncias para a Guerra Química/intoxicação , Planejamento em Desastres , Terrorismo , Antídotos/administração & dosagem , Descontaminação , Intoxicação por Gás/diagnóstico , Intoxicação por Gás/tratamento farmacológico , Intoxicação por Gás/prevenção & controle , Guias como Assunto , Humanos
13.
Tidsskr Nor Laegeforen ; 124(6): 779-81, 2004 Mar 18.
Artigo em Norueguês | MEDLINE | ID: mdl-15039807

RESUMO

BACKGROUND: Severe sepsis is a common cause of mortality in critically ill patients. Drotrecogin alfa (activated), synonymous with recombinant human activated protein C (rhAPC), is a new therapeutic tool with anticoagulant, anti-inflammatory and profibrinolytic properties with proven effect in reducing mortality in severe sepsis. MATERIAL AND METHODS: As part of a multi-centre study, the patients received an infusion of rhAPC, 24 microg/kg/h for 96 hours according to an open-labeled phase IIIb study protocol. RESULTS: Out of a total of 28 patients, 6 (21%) died before day 28. One of the deaths was classified as possibly related to rhAPC. In three patients rhAPC was transiently stopped because of surgery or postoperative bleeding. Use of the compound rarely interfered with commonly used diagnostic and therapeutic procedures. INTERPRETATION: Treatment with rhAPC is easily carried out in an intensive care unit. Patients with severe sepsis and two or more failing vital organs should be considered for treatment with rhAPC.


Assuntos
Anti-Infecciosos/uso terapêutico , Fibrinolíticos/uso terapêutico , Proteína C/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Sepse/tratamento farmacológico , Adulto , Idoso , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/economia , Causas de Morte , Custos de Medicamentos , Feminino , Fibrinolíticos/efeitos adversos , Fibrinolíticos/economia , Seguimentos , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/economia , Sepse/mortalidade
14.
Tidsskr Nor Laegeforen ; 122(25): 2444-6, 2002 Oct 20.
Artigo em Norueguês | MEDLINE | ID: mdl-12448112

RESUMO

BACKGROUND: Poisoning with ethylene glycol causes severe metabolic acidosis and renal failure, and is potentially lethal if not treated rapidly. Until recently the standard therapy for this poisoning has been bicarbonate to counteract the metabolic acidosis, inhibition of alcohol dehydrogenase (ADH) with ethanol to prevent the production of toxic metabolites and haemodialysis to remove ethylene glycol and its toxic metabolites. The new potent inhibitor of ADH, 4-methylpyrazole (fomepizole), has recently been approved for the treatment of methanol and ethylene glycol poisonings. MATERIAL AND METHODS: Three patients severely poisoned by ethylene glycol and treated with fomepizole are presented. RESULTS: Of our three patients treated with fomepizole two were managed without haemodialysis. One patient had an exceptionally high serum ethylene glycol concentration (90 mmol/l; 585 mg/dl) and was successfully treated with fomepizole without the need for haemodialysis despite pronounced metabolic acidosis. INTERPRETATION: Ethylene glycol poisonings may be treated effectively with fomepizole without haemodialysis.


Assuntos
Antídotos/administração & dosagem , Etilenoglicol/intoxicação , Intoxicação/tratamento farmacológico , Pirazóis/administração & dosagem , Adulto , Etilenoglicol/sangue , Feminino , Fomepizol , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade
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