Potential therapies for sodium azide intoxication; a case report and review of the literature.

Intoxications with sodium azide are rare and in almost all cases lethal in doses above 700 mg or 10mg/kg. We report a case of a patient who ingested 2 grams of sodium azide as a suicide attempt. Sodium azide irreversible blocks cytochrome C oxidase by inhibiting oxidative phosphorylation leading to cell death. There is currently no antidote available. Our patient was treated with a range of therapies, on site, in the emergency department and in the intensive care unit, such as sodium thiosulphate, methylene blue, intralipid, extensive gastric lavage, whole bowel irrigation combined with pro-kinetics, hydroxocobalamin and exchange transfusion. During the clinical course the patient developed cardiac failure, for which veno-arterial ECMO and an intra-aortic balloon pump was placed. However, cardiac function did not recover, leading to discontinuation of treatment after 7 days. As literature on sodium azide intoxication is scarce, we conducted a review to present potential treatment options.

[From facial pain to toxic epidermal necrolysis: a rare complication of carbamazepine usage]. / Van aangezichtspijn naar toxische epidermale necrolyse.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare disease that is characterised by epidermal loss, often as a result of medication use - particularly sulfonamides and anti-epileptics. People of South-East Asian descent are at increased risk of developing TEN since they may carry the HLA-B*1502 allele. CASE DESCRIPTION: A 61-year-old female of Indonesian descent developed TEN due to carbamazepine use, resulting in admission to the intensive care department of a specialised burn centre in the Netherlands. She was successfully treated with high-dose prednisone and local therapy for the skin disorder. CONCLUSION: The US Food and Drug Administration advises screening of patients of South-East Asian descent for HLA-B*1502 prior to initiation of treatment with TEN-related medication. In the Netherlands, screening for this allele is currently not mandatory.

Prediction of the anti-RhD donor population size for managerial decision-making.

BACKGROUND: Rhesus D (RhD)-negative women pregnant with a RhD-positive child receive prophylactic injections to prevent haemolytic disease of the newborn. Because of the success of the prophylaxis, the number of naturally immunized women has decreased, thereby also decreasing the number of potential donors who provide the plasma from which the prophylaxis is made. As the current donor pool is ageing, the availability of the prophylaxis is threatened. OBJECTIVES: Objectives are to investigate whether the anti-D population and the changes therein can be described by a relatively simple model, to determine the impact of ageing of the anti-D donors on the decline of the population and how many new donors should be recruited to meet future supply demand. METHODS: Data on Dutch anti-D donors in 1994-2013 were used to simulate the donor population size and age composition for various donor recruitment scenarios. RESULTS: With a continuous influx of 27 new donors per year and a donor stopping rate of 10% per year, the population size will stabilize at 195 donors, with 2·3% of donors stopping annually due to reaching the donor age limit. A formula is derived to estimate which donor recruitment and retention efforts are required to maintain a prespecified donor pool. CONCLUSION: A relatively simple model can already describe and predict the size of the anti-D donor population and the impact of ageing accurately.