Lipid emulsion improves Glasgow coma scale and decreases blood glucose level in the setting of acute non-local anesthetic drug poisoning--a randomized controlled trial.

BACKGROUND: To date, no study has been performed to evaluate the antidotal effect of intravenous lipid emulsion on the poisoned patients' level of consciousness and routine metabolic profile tests in non-local anesthetic drug overdose. OBJECTIVES: Our aim was to evaluate the effect of intravenous intralipid administration as an antidote on the poisoned patients' Glasgow Coma Scale (GCS), hemodynamic parameters, arterial blood gas analysis, and routine metabolic profile tests (i.e., urea, glucose, sodium, and potassium) in the setting of non-local anesthetic drug overdose. MATERIAL AND METHODS: In this randomized controlled trial, a total of 30 patients with non-local anesthetic drug intoxication were enrolled and randomly assigned into case (n=15) and control (n=15) groups. In the case group, all patients received 10 cc/kg intralipid 10% infusion. The patients in the control group just received the supportive care. Patients' demographic and clinical characteristics and results of their laboratory tests were evaluated at presentation and 6 hours after that. RESULTS: Mean age was 23 +/- 5 and 28 +/- 11 years in cases and controls, respectively. There were no significant statistical differences between these two groups regarding age, gender, elapsed time between intubation and extubation, and need for intubation and/or mechanical ventilation (p = 0.70 and p = 1.00, respectively). Also, systolic blood pressure, pulse rate, mean rate pressure product, respiratory rate, results of arterial blood gas analyses, serum sodium, potassium, urea, and creatinine on presentation and six hours later were not statistically significantly different between the two study groups. However, a significant difference was found between the two groups in terms of GCS difference (p = 0.048) and blood glucose six hours after presentation (p = 0.04). CONCLUSIONS: In the setting of non-local anesthetic drug overdose, intravenous intralipid infusion can increase GCS and interestingly, decrease the blood glucose.

The role of ultrasound in the visualization of the ingested medications in acute poisoning - a literature review.

In the patients with medication poisoning, diagnosis and treatment may be complicated due to the decreased level of consciousness or lack of the patient cooperation. In this review, we tried to assess the role of ultrasonography in detection of the ingested medication in the stomach of the patients with suspected medication poisoning. Of the studies performed in this regard, only one managed to determine the extended phenytoin capsules in the stomach of a poisoned patient. In actual acute poisoning - even in the hands of an experienced ultrasonographer - detection of the medications in the patients' stomach seems to be difficult due to the presence of the food or lack of the water in their stomach. Also, after dissolution of the tablets or capsules or their passage from the pylorus, they can not further been visualized by ultrasound. We, therefore, conclude that ultrasonography is not an appropriate tool for diagnosis of the medication ingestion in acute poisoning.