ABSTRACT
We present two cases, in which end-of-life patients were inadvertently treated with bolus infusions of undiluted subcutaneous levetiracetam. The patients were treated for three and four days respectively. In both cases, the course of treatment was uneventful. Especially, no seizures, nor local irritation was observed. Administration of undiluted subcutaneous levetiracetam as intermittent bolus infusions by hand holds alluring properties for end-of-life patients. Amongst others reducing patient discomfort, increasing freedom of movement, and accessibility to essential seizure prophylaxis by eliminating the need for a syringe driver, thereby helping accommodate many patients wish to die in their own home. However, pharmacokinetics, efficacy, and safety, including the optimum dilution and administration time of the subcutaneous preparation remains to be determined in clinically controlled trials.
Subject(s)
Anticonvulsants , Infusions, Subcutaneous , Levetiracetam , Terminal Care , Humans , Levetiracetam/administration & dosage , Anticonvulsants/administration & dosage , Anticonvulsants/pharmacokinetics , Male , Terminal Care/methods , Female , Aged , Piracetam/analogs & derivatives , Piracetam/administration & dosage , Middle Aged , Seizures/drug therapy , Aged, 80 and overABSTRACT
Venous air embolism (VAE) is a well-known complication to trauma and various surgical, diagnostic and therapeutically procedures. Small iatrogenic VAE during contrast-enhanced computed tomography (CeCT) are frequent and often asymptomatic. We present a case of iatrogenic VAE during CeCT, where the patient instead of contrast had 100 ml of atmospheric air injected intravenously. The patient developed symptoms of VAE with clinical cardiac arrest, but survived and was discharged without any clinical evidence of embolic sequelae five days after the tomography.
Subject(s)
Embolism, Air/etiology , Heart Arrest/etiology , Iatrogenic Disease , Injections, Intravenous/adverse effects , Contrast Media , Female , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Gas embolism is the entry of air or medical gases into the blood circulation following invasive procedures, surgery, trauma or diving. The mortality of symptomatic gas embolism is high. Time is of the essence when initiating treatment, and gas embolism is often easily prevented. In this article, aetiology, frequency, pathophysiology, symptoms, diagnosis, treatment, outcome and prevention of both venous and arterial iatrogenic gas embolism are reviewed.
Subject(s)
Embolism, Air , Iatrogenic Disease , Embolism, Air/diagnosis , Embolism, Air/prevention & control , Embolism, Air/therapy , Humans , Risk Factors , Time FactorsABSTRACT
Death as a result of air embolism has been reported following sexual activity such as vaginal insufflation or coitus a tergo. It is a very uncommon cause of death, however, during pregnancy and puerperium the risk increases due to non-collapsible veins at the placental site. Air embolism should be suspected in all sudden female deaths related to sexual activity in order to initiate appropriate treatment to minimize maternal and fetal morbidity and mortality.
