RESUMEN
INTRODUCTION: The HIV epidemic in Tijuana, Mexico is concentrated in key populations, including people who inject drugs (PWID). However, HIV interventions among PWID are minimal, and federal funding was provided for compulsory abstinence programmes associated with HIV and overdose. Alternatively, opioid agonist therapy reduces overdose, reincarceration, HIV, while improving antiretroviral therapy (ART) outcomes. We assessed potential impact and synergies of scaled-up integrated ART and opioid agonist therapy, compared to scale-up of each separately, and potential harms of compulsory abstinence programmes on HIV and fatal overdose among PWID in Tijuana. METHODS: We developed a dynamic model of HIV transmission and overdose among PWID in Tijuana. We simulated scale-up of opioid agonist therapy from zero to 40% coverage among PWID. We evaluated synergistic benefits of an integrated harm reduction and ART scale-up strategy (40% opioid agonist therapy coverage and 10-fold ART recruitment), compared to scale-up of each intervention alone or no scale-up of low coverage ART and no harm reduction). We additionally simulated compulsory abstinence programmes (associated with 14% higher risk of receptive syringe sharing and 76% higher odds of overdose) among PWID. RESULTS: Without intervention, HIV incidence among PWID could increase from 0.72 per 100 person-years (PY) in 2020 to 0.92 per 100 PY in 2030. Over ten years, opioid agonist therapy scale-up could avert 31% (95% uncertainty interval (UI): 18%, 46%) and 22% (95% UI: 10%, 28%) new HIV infections and fatal overdoses, respectively, with the majority of HIV impact from the direct effect on HIV transmission due to low ART coverage. Integrating opioid agonist therapy and ART scale-up provided synergistic benefits, with opioid agonist therapy effects on ART recruitment/retention averting 9% more new infections compared to ART scale-up alone. The intervention strategy could avert 48% (95% UI: 26%, 68%) of new HIV infections and one-fifth of fatal overdoses over ten years. Conversely, compulsory abstinence programmes could increase HIV and overdoses. CONCLUSIONS: Integrating ART with opioid agonist therapy could provide synergistic benefits and prevent HIV and overdoses among PWID in Tijuana, whereas compulsory abstinence programmes could cause harm. Policymakers should consider the benefits of integrating harm reduction and HIV services for PWID.
Asunto(s)
Analgésicos Opioides/agonistas , Fármacos Anti-VIH/uso terapéutico , Sobredosis de Droga/complicaciones , Infecciones por VIH/tratamiento farmacológico , Reducción del Daño , Abuso de Sustancias por Vía Intravenosa/complicaciones , Sobredosis de Droga/tratamiento farmacológico , Epidemias , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , México/epidemiología , Modelos Biológicos , Compartición de AgujasRESUMEN
ABSTRACT This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of β-adrenergic agonists in the context of a probable factitious disorder.
RESUMO O presente estudo relata o caso de um jovem de 13 anos de idade com histórico, há três anos, de episódios de hipocalemia grave intermitente de origem desconhecida, internado em unidade de terapia intensiva (UTI) por síndrome do QT longo (SQTL). O paciente foi diagnosticado com hipocalemia por redistribuição secundária ao abuso de agonistas β-adrenérgicos, em contexto de provável transtorno factício.
Asunto(s)
Humanos , Masculino , Adolescente , Síndrome de QT Prolongado/inducido químicamente , Agonistas Adrenérgicos beta/efectos adversos , Trastornos Fingidos/diagnóstico , Hipopotasemia/inducido químicamente , Potasio/sangre , Potasio/uso terapéutico , Recurrencia , Síndrome de QT Prolongado/psicología , Agonistas Adrenérgicos beta/sangre , Albuterol/sangre , Sobredosis de Droga/complicaciones , Hipopotasemia/psicología , Hipopotasemia/sangreRESUMEN
INTRODUCTION: Aripiprazole is an atypical antipsychotic with partial agonism at dopamine and serotonin receptors. In pediatrics, it is approved to treat irritability associated with autistic disorder along with other neuropsychological conditions. Compared with other atypical antipsychotics, it has a favorable side effect profile, but overdose experience is limited. CASE REPORT: A 3-year-old drug-naive patient accidentally ingested 200 mg of aripiprazole. This ingestion resulted in immediate lethargy with brief improvement 16 hours after ingestion and subsequent decline 2 hours later. Patient returned to baseline 72 hours after ingestion. DISCUSSION: Unlike previous case reports, this patient displayed a biphasic course of somnolence. Previous reports have described delayed onset and prolonged sedation in response to an aripiprazole overdose. Current recommendations regarding monitoring after ingestion do not account for possible worsening of symptoms after improvement. CONCLUSION: It is important to recognize the need for a longer observation period after a significant aripiprazole overdose as a variable course of somnolence may be witnessed.
Asunto(s)
Antipsicóticos/toxicidad , Aripiprazol/toxicidad , Sobredosis de Droga/complicaciones , Preescolar , Ingestión de Alimentos , Humanos , Masculino , Observación/métodos , SomnolenciaRESUMEN
This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of ß-adrenergic agonists in the context of a probable factitious disorder.
Asunto(s)
Agonistas Adrenérgicos beta/efectos adversos , Trastornos Fingidos/diagnóstico , Hipopotasemia/inducido químicamente , Síndrome de QT Prolongado/inducido químicamente , Adolescente , Agonistas Adrenérgicos beta/sangre , Albuterol/sangre , Sobredosis de Droga/complicaciones , Humanos , Hipopotasemia/sangre , Hipopotasemia/psicología , Síndrome de QT Prolongado/psicología , Masculino , Potasio/sangre , Potasio/uso terapéutico , RecurrenciaRESUMEN
Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma. A magnetic resonance imaging done at the eighth day, showed hyperintensity of the oval center and corpus callosum which disappeared in a new imaging study done 30 days later, where images of hypoxia in the basal nuclei and cortex appeared. The patient died forty seven days after admission. Up-gaze is an ominous oculomotor alteration linked to an important but incomplete damage in the cerebral cortex, a condition that perverts some sequences of the ocular opening, reversing the Bell phenomenon and producing eyelid retraction.
Asunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Bupropión/efectos adversos , Coma/inducido químicamente , Sobredosis de Droga/complicaciones , Hipoxia Encefálica/inducido químicamente , Trastornos de la Motilidad Ocular/inducido químicamente , Anciano , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Trastornos de la Personalidad/tratamiento farmacológico , SuicidioRESUMEN
Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma. A magnetic resonance imaging done at the eighth day, showed hyperintensity of the oval center and corpus callosum which disappeared in a new imaging study done 30 days later, where images of hypoxia in the basal nuclei and cortex appeared. The patient died forty seven days after admission. Up-gaze is an ominous oculomotor alteration linked to an important but incomplete damage in the cerebral cortex, a condition that perverts some sequences of the ocular opening, reversing the Bell phenomenon and producing eyelid retraction.
Asunto(s)
Humanos , Femenino , Anciano , Trastornos de la Motilidad Ocular/inducido químicamente , Hipoxia Encefálica/inducido químicamente , Bupropión/efectos adversos , Coma/inducido químicamente , Antidepresivos de Segunda Generación/efectos adversos , Sobredosis de Droga/complicaciones , Trastornos de la Personalidad/tratamiento farmacológico , Suicidio , Imagen por Resonancia Magnética , Resultado FatalAsunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Sobredosis de Droga/complicaciones , Metotrexato/efectos adversos , Mucositis/inducido químicamente , Estomatitis/inducido químicamente , Adulto , Antirreumáticos/administración & dosificación , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Sobredosis de Droga/patología , Femenino , Humanos , Metotrexato/administración & dosificación , Mucositis/patología , Necrosis , Estomatitis/patologíaAsunto(s)
Antiarrítmicos/envenenamiento , Síndrome de Brugada/inducido químicamente , Sobredosis de Droga/complicaciones , Propafenona/envenenamiento , Choque Cardiogénico/inducido químicamente , Adulto , Síndrome de Brugada/fisiopatología , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Choque Cardiogénico/fisiopatologíaAsunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Choque Cardiogénico/inducido químicamente , Propafenona/envenenamiento , Síndrome de Brugada/inducido químicamente , Sobredosis de Droga/complicaciones , Antiarrítmicos/envenenamiento , Choque Cardiogénico/fisiopatología , Electrocardiografía , Síndrome de Brugada/fisiopatologíaAsunto(s)
Humanos , Femenino , Adulto , Artritis Reumatoide/tratamiento farmacológico , Estomatitis/inducido químicamente , Metotrexato/efectos adversos , Antirreumáticos/efectos adversos , Mucositis/inducido químicamente , Sobredosis de Droga/complicaciones , Estomatitis/patología , Metotrexato/administración & dosificación , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Antirreumáticos/administración & dosificación , Mucositis/patología , Sobredosis de Droga/patología , NecrosisAsunto(s)
Anticonvulsivantes/toxicidad , Sobredosis de Droga/complicaciones , Seudoquiste Pancreático/inducido químicamente , Pancreatitis/inducido químicamente , Ácido Valproico/toxicidad , Adulto , Sobredosis de Droga/etiología , Humanos , Lipasa/sangre , Masculino , Seudoquiste Pancreático/sangre , Seudoquiste Pancreático/diagnóstico , Pancreatitis/sangre , Pancreatitis/diagnóstico , RecurrenciaRESUMEN
BACKGROUND: Pharmacobezoars are aggregates of undigested medications that accumulate in the gastrointestinal tract and can cause obstructive or toxic complications. In this paper, the first case is reported of a paediatric pharmacobezoar formation after a vitamin overdose. The objective of this report is to prevent the occurrence of this complication and the action to be taken. CLINIC CASE: A 6-year-old child, 6h after ingesting 40 chewable tablets of a hydrophobic vitamin E with high capacity to form a pharmacobezoar, underwent urgent oesophagogastroscopy. A viscoelastic mass of 10×4cm was observed stretching from the cardia to the greater curvature. Seventy-five percent of the mass was removed and the remainder was fragmented, hydrated and aspirated. The patient remains asymptomatic to date. CONCLUSIONS: An overdose of hydrophobic drugs can produce a bezoar formation therefore prompt evacuation is recommended with an upper gastrointestinal endoscopy, which is a safe and effective technique in gastric bezoars.
Asunto(s)
Bezoares/cirugía , Cápsulas/efectos adversos , Sobredosis de Droga/complicaciones , Esofagoscopía/métodos , Gastroscopía/métodos , Estómago , Bezoares/etiología , Niño , Composición de Medicamentos , Gelatina , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Masculino , Vitamina E/administración & dosificaciónRESUMEN
La dapsona es una sulfona. Esta ha sido de gran ayuda en el tratamiento de distintos tipos de lepra. Es también efectiva en el tratamiento de la dermatitis herpetiforme, pénfigos y en el tratamiento y prevención de la neumonía por Pneumocystis carinii y de la toxoplasmosis en pacientes con SIDA. Los efectos adversos más comunes son la metahemoglobinemia y la anemia hemolítica; esta última ha sido descripta en pacientes con déficit de glucosa 6-fosfato dehydrogenasa. Estas reacciones están frecuentemente relacionadas con las dosis. Presentamos dos pacientes que tomaron intencionalmente una sobredosis de 3 y 30 (100 mg) tabletas respectivamente. Los signos de intoxicación fueron cianosis, náuseas, vómitos, dolor abdominal y cefalea. Las concentraciones de metahemoglobina variaron de 29,3% a 50%. El tratamiento incluyó medidas de sostén y azul de metileno endovenoso. El Joven de 14 años desarrolló una elevación de enzimas hepáticas. La metahemoglobinemia se normalizó en 36 horas en el primer paciente y en una semana en el segundo(AU)
Asunto(s)
Niño , Dapsona/efectos adversos , Dapsona/diagnóstico , Sobredosis de Droga/complicaciones , Azul de Metileno/administración & dosificación , Automedicación , Intento de SuicidioAsunto(s)
Humanos , Sobredosis de Droga/complicaciones , Intoxicación/complicaciones , Álcalis/efectos adversos , Álcalis/toxicidad , Carbamatos/efectos adversos , Carbamatos/envenenamiento , Carbamatos/toxicidad , Hidrocarburos/efectos adversos , Hidrocarburos/envenenamiento , Hidrocarburos/toxicidad , Insecticidas Organoclorados/efectos adversos , Insecticidas Organoclorados/envenenamiento , Insecticidas Organoclorados/toxicidad , Metanol/efectos adversos , Metanol/envenenamiento , Metanol/toxicidadRESUMEN
Se presenta el caso de una niña de 2 años y 9 meses de edad, a quien una curandera indica la administración de aceite de epazote (aceite de quenopodio) como vermífugo, en dos tomas de 20 ml cada una. Después de la segunda manifiesta coma profundo, convulciones, midriasis, apnea, acidosis metabólica, choque neurogénico y muerte. ElEEG mostró un trazo sugestivo de encefalopatía, la TAC con imagen de edema cerebral y colapso ventricular. El estudio postmortem ratificó el edema cerebral y microscópicamente evidenció necrosis neuronal difusa; otros hallazgos fueron neumonía, enteritis, peicolangitis, pancreatitis incipiente y necrosisi tubular, el análisis fitoquímico del aceite identificó ascaridol, principio activo de las quenopodáceas, en cantidad 39 mg/ml (1,560 mg en los 40 ml ingeridos) y a chenopodium graveolens como la planta de la que se obtuvo el aceite, conforme al método como históricamente se adminstraba el aceite, la paciente debió haber ingerido una dosis total de ascaridol de 60 mg, por lo que la cantidad administrada fue 26 veces superior, además que excedía 56 por ciento la dosis de 1,000 mg, informada como letal en humanos.
Asunto(s)
Preescolar , Humanos , Antihelmínticos/efectos adversos , Sobredosis de Droga/complicaciones , Medicina de Hierbas , Errores de Medicación , Medicina Tradicional , Extractos Vegetales/efectos adversos , Intoxicación por Plantas/clasificación , Plantas Medicinales/química , Terpenos/toxicidad , Toxicología/clasificaciónRESUMEN
OBJECTIVES: To evaluate the association of fasting and alcohol use with hepatotoxicity from acetaminophen ingested for therapeutic reasons. DESIGN: Retrospective case series. SETTING: Hospitals of the University of Pittsburgh (Pa) Medical Center. PATIENTS: A total of 126,779 discharge summaries from January 1987 to July 1993 were reviewed using a comprehensive, whole-text-indexed medical database to identify all patients with acetaminophen ingestion and hepatotoxicity. These patients were categorized according to the intended acetaminophen use and dose of acetaminophen ingested. MAIN OUTCOMES MEASURED: The independent variables of chronic alcohol use, recent alcohol use, and recent fasting were determined for all patients. RESULTS: Forty-nine patients with acetaminophen hepatotoxicity (aspartate aminotransferase > 1000 U/L) were identified. Twenty-one patients (43%) ingested acetaminophen for therapeutic purposes. All patients with hepatotoxicity took more than the recommended limit of 4 g/d. Recent fasting was more common than recent alcohol use among those who suffered hepatotoxicity after a dose of 4 to 10 g of acetaminophen per day (P = .02). Recent alcohol use was more common in the group who took more than 10 g/d than in those who took 4 to 10 g/d (P = .004). CONCLUSION: Acetaminophen hepatotoxicity after a dose of 4 to 10 g/d was associated with fasting and less commonly with alcohol use. Patients who developed hepatoxicity after taking acetaminophen doses of greater than 10 g/d for therapeutic purposes were alcohol users. Acetaminophen hepatotoxicity after an overdose appears to be enhanced by fasting in addition to alcohol ingestion.
Asunto(s)
Acetaminofén/efectos adversos , Alcoholismo/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas , Etanol/efectos adversos , Ayuno/efectos adversos , Acetaminofén/metabolismo , Acetaminofén/envenenamiento , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Sobredosis de Droga/complicaciones , Sinergismo Farmacológico , Etanol/metabolismo , Ayuno/metabolismo , Femenino , Humanos , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A two-year retrospective review of accidental albuterol ingestions in children less than 12 years old was performed to assess overdose toxicity and to investigate a dose-effect relationship. One hundred twelve exposures were located. Seventeen cases were excluded owing to coingestants, leaving 95 cases for evaluation. Twenty-nine children (30%) remained at home without intervention or telephone followup because of an ingestion of less than 0.6 mg/kg. Twenty-eight patients (30%) were followed at home by telephone (12 of whom received ipecac). Dosages ranged from 1 to 27 mg, with dose/weight ratios of 0.1 to 1.9 mg/kg. Two children experienced transient mild symptoms (irritability, brief nausea, and vomiting). The remaining 26 children were asymptomatic. Thirty eight cases (40%) were treated in an emergency department. Ingestions ranged from 2 to 96 mg, with dose/weight ratios of 0.3 to 6.3 mg/kg. Ages ranged from one to 11 years. Transient restlessness or irritability was observed in 16 patients, tachycardia in 15, tremors in six, and a widened pulse pressure in one. No serious events occurred in this series, and no patient required treatment beyond gastrointestinal decontamination. For ingestions of 0.6 mg/kg or less, treatment at home with observation may be sufficient. For larger ingestions, eg, greater than 0.6 mg/kg, consideration should be given to direct medical evaluation and gastrointestinal decontamination.