RESUMEN
BACKGROUND: A 53-year-old male with no pre-existing conditions and no permanent medication presented to our emergency department with an anticholinergic syndrome including confusion, anxiety, ataxia and dysarthria after ingestion of a homeopathic solution containing Atropa belladonna extract supposedly in a D4 dilution. METHODS: Atropine sulphate was quantitatively analysed in serum and the homeopathic preparation via liquid chromatography/mass spectrometry. RESULTS: Analysis revealed concentrations of approximately 3 mg/mL atropine sulphate in the homeopathic solution and a serum level of 5.7 ng/mL (±1.4) in the patient's blood proving a 600-fold overdose of atropine due to a production error of the homeopathic dilution. The patient was observed and recovered without further intervention. CONCLUSION: Rare but possibly dangerous manufacturing errors should be considered when faced with symptoms occurring after ingestion of homeopathic or holistic remedies.
Asunto(s)
Síndrome Anticolinérgico , Atropa belladonna , Síndrome Anticolinérgico/etiología , Síndrome Anticolinérgico/terapia , Atropa belladonna/química , Atropina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Antagonistas Muscarínicos , Extractos Vegetales/químicaAsunto(s)
Anestesia/efectos adversos , Arritmias Cardíacas/terapia , Fiebre/terapia , Complicaciones Intraoperatorias/terapia , Taquicardia/terapia , Inconsciencia/terapia , Adulto , Síndrome Anticolinérgico/diagnóstico , Síndrome Anticolinérgico/terapia , Diagnóstico Diferencial , Femenino , Fiebre/etiología , Humanos , Síndrome Neuroléptico Maligno/diagnóstico , Síndrome Neuroléptico Maligno/prevención & control , Síndrome Neuroléptico Maligno/terapia , Taquicardia/etiología , Inconsciencia/etiologíaRESUMEN
Malignant hyperthermia is a life-threatening disease caused by derangement of the autonomic nerve system and hypermetabolism of the peripheral musculature. Commonly body core temperatures of more than 40 °C will be found in this disease which is caused mostly by psychopharmacological drugs like antidepressants, neuroleptics but also antibiotics, pain killers, anti-Parkinson drugs, and volatile anesthetics. The inducers of malignant hyperthermia interact with postsynaptic receptors (serotonin, anticholinergics) or muscular intracellular structures responsible for calcium utilization (volatile anesthetics, succinylcholine). Rarely malignant hyperthermia is a consequence of mental stress or vigorous exercise and or heat. Malignant hyperthermic syndromes lead to a severe dysbalance of the autonomic nerve system accompanied by rhabdomyolysis, disseminated intravascular coagulopathy, and finally multi-organ failure. Accordingly, medical management is primarily directed to stabilize vital functions, withdrawal of the causing drug, and if possible antagonizing toxic substances. The leading symptom hyperthermia needs to be treated physically with available cooling systems.
Asunto(s)
Unidades de Cuidados Intensivos , Hipertermia Maligna/diagnóstico , Hipertermia Maligna/etiología , Síndrome Anticolinérgico/diagnóstico , Síndrome Anticolinérgico/fisiopatología , Síndrome Anticolinérgico/terapia , Sistema Nervioso Autónomo/fisiopatología , Diagnóstico Diferencial , Golpe de Calor/diagnóstico , Golpe de Calor/etiología , Golpe de Calor/fisiopatología , Golpe de Calor/terapia , Humanos , Hipertermia Maligna/fisiopatología , Hipertermia Maligna/terapia , Músculo Esquelético/fisiopatología , Síndrome Neuroléptico Maligno/diagnóstico , Síndrome Neuroléptico Maligno/fisiopatología , Síndrome Neuroléptico Maligno/terapia , Síndrome de Infusión de Propofol/diagnóstico , Síndrome de Infusión de Propofol/fisiopatología , Síndrome de Infusión de Propofol/terapia , Rabdomiólisis/diagnóstico , Rabdomiólisis/etiología , Rabdomiólisis/fisiopatología , Rabdomiólisis/terapia , Síndrome de la Serotonina/diagnóstico , Síndrome de la Serotonina/fisiopatología , Síndrome de la Serotonina/terapiaRESUMEN
OBJECTIVE: The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents. CASE SUMMARY: A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg daily, as well as hyoscyamine, ondansetron, montelukast, and a course of nitazoxanide. She was also routinely given diphenhydramine and omeprazole. Three days after increasing sertraline to 12.5 mg, she presented to the emergency department with altered mental status, hallucinations, mydriasis, tachycardia, and pyrexia. She was admitted to the pediatric intensive care unit and subsequently treated unsuccessfully for serotonin syndrome, with blurred vision and clonus persisting at discharge 4 days after admittance. Upon follow-up with her outpatient clinic, all anticholinergic agents were discontinued, and symptoms slowly resolved. CONCLUSIONS: This case illustrates the importance of differential diagnosis between toxidromes and how clinical presentation can be altered by preexisting conditions as well as the use of medications that affect multiple neurotransmitter systems.
Asunto(s)
Síndrome Anticolinérgico/diagnóstico , Antagonistas Colinérgicos/efectos adversos , Síndrome de la Serotonina/diagnóstico , Síndrome Anticolinérgico/etiología , Síndrome Anticolinérgico/terapia , Niño , Diagnóstico Diferencial , Femenino , Humanos , Serotoninérgicos/efectos adversos , Síndrome de la Serotonina/inducido químicamente , Síndrome de la Serotonina/terapia , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Sertralina/efectos adversosAsunto(s)
Síndrome Anticolinérgico/etiología , Enfermedades Transmitidas por los Alimentos/etiología , Papaveraceae/envenenamiento , Intoxicación por Plantas/etiología , Plantas Tóxicas , Síndrome Anticolinérgico/diagnóstico , Síndrome Anticolinérgico/fisiopatología , Síndrome Anticolinérgico/psicología , Síndrome Anticolinérgico/terapia , Enfermedades Transmitidas por los Alimentos/diagnóstico , Enfermedades Transmitidas por los Alimentos/fisiopatología , Enfermedades Transmitidas por los Alimentos/psicología , Enfermedades Transmitidas por los Alimentos/terapia , Humanos , Masculino , Persona de Mediana Edad , Intoxicación por Plantas/diagnóstico , Intoxicación por Plantas/fisiopatología , Intoxicación por Plantas/psicología , Intoxicación por Plantas/terapia , Resultado del TratamientoRESUMEN
While reading special literature in diferent languages the authors noted surprising fact: the term and concept of "central anticholinergic syndrome" is well-known as common anaesthesia complication in German (abbr: ZAS) and partially Spanish sources, but in Russian, English or French literature is used only in toxicological context. Describing etiology, pathogenesis, symptoms, diagnosis and treatment of the complication manifesting with comatose, agitated or shivering forms, the authors analyzing the reasons for such a noticeably diferent approaches to the situation reaching 10% of all the general anaesthesia cases. Probably, ZAS isn't nosologically clearly defined syndrome, but just adverse appearance of one of the fundamental general anaesthesia mechanisms? Anyway, the problem of central cholinergic activity suppression, excessive by its amplitude and/or duration, exists all over the world. German concept of ZAS allows the anaesthesiologist to resolve it on pathogenically generalized basis, while in other professional communities various symptomatic approaches seem to be more common.
Asunto(s)
Anestesia General/efectos adversos , Síndrome Anticolinérgico/etiología , Antagonistas Colinérgicos/efectos adversos , Periodo de Recuperación de la Anestesia , Síndrome Anticolinérgico/diagnóstico , Síndrome Anticolinérgico/terapia , HumanosRESUMEN
Se presenta un caso clínico poco habitual de intoxicación secundaria a ingesta de alcaloides procedentes de altramuces, consumidos con frecuencia por su valor nutricional. Se describen los efectos adversos más frecuentes tras la ingesta de lupino, que incluyen: síntomas anticolinérgicos y alteraciones del SNC leves y se expone el manejos de su intoxicación. El caso ilustra la dificultad que entraña el diagnóstico y la importancia de una buena anamnesis y exploración fisica detalladas (AU)
An unusual clinical case of secondary poisoning after intake of lupine alkaloids, often consumed for its nutritional value is presented. Most frequent side effects after intake of lupine are described, including anticholinergic symptoms and mild CNS disorders and management of poisoning is discussed. The case illustrates the difficulty of diagnosis and the importance of a good history and detailed phusical examination (AU)