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1.
J Emerg Med ; 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32532580

RESUMO

BACKGROUND: Hundreds of years ago, humans realized that animals could be used as surrogate indicators of toxic environmental exposures, as a tool to measure risk to human health. The classic example is coal miners bringing canaries into coal mines. The respiratory rate and metabolism of the animal resulted in toxic signs of injurious gases in the environment before humans were injured. Occasionally, modern diagnosis of cryptic toxic exposures can be aided by the discovery of such features in the history. OBJECTIVES: We introduce this review using a case of inhalational mercury toxicity involving humans and companion animals-household dogs and cats. The death of exposed pets prior to the mounting of symptoms in the exposed humans was advance warning of the near-fatal presentation to come. Our objective was to review and characterize the state of the literature on companion animals as sentinel species. DISCUSSION: We reviewed 748 articles, which resulted in 25 selected for inclusion in this narrative review. We detail examples of companion animals (household dogs, cats, and birds) affected by toxic exposures in acute and chronic ways-acting as harbingers of impending human toxicity in acute or chronic settings. Mercury, lead, Teflon, herbicide, and asbestos exposures present with predictable signs and symptoms in companion animals prior to presenting in humans. Identifying the toxidrome in a companion animal allows for subclinical identification of exposure and consequences in the human that permits early treatment and intervention. CONCLUSIONS: Companion animals, when similarly exposed to toxic substances as humans regarding route, dose, and chronicity often mount symptoms and signs in advance of humans. This phenomenon allows the clinician to identify occult exposure, test, and treat while human disease is mild or still subclinical.

2.
Clin Ther ; 42(2): 286-294.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32029287

RESUMO

PURPOSE: Assessment of pain is difficult for many reasons, including the inability of patients to translate a subjective experience into words, and it is challenging for health care providers to create a shared understanding of what is being described. Physical representations exist to facilitate the objective scaling of "severity" or "intensity" of pain, but none exist to enable communication of pain quality. The objective of this proof-of-concept study was to develop, introduce, and evaluate consistency of participant interpretation of a novel kinesthetic tool set (Pain Blocks) that was designed to represent qualities of pain. METHODS: A prospective convenience sampling of participants approached in nonmedical settings over 9 months was queried to assess 6 randomly ordered Pain Blocks during structured interviews. The subjects were directed to associate each Pain Block with a pain quality from a list of 12 suggestions or use a free-text area for "other" descriptors. During the study, Pain Blocks were removed and replaced based on consistency of response at interval assessments. In part 2, participants were asked if any of the Pain Blocks accurately characterized the quality of their last severe pain. FINDINGS: A convenience sample of 220 participants was enrolled in the study and assessed 6 Pain Blocks. They interpreted and applied a pain quality to each of the blocks. Using interval assessments, a final selection of 6 Pain Blocks was derived that had consistent high association with specific pain qualities, either individually or with synonyms: Block 1 (stretching and tearing), 81.8%; Block 3 (crampy and throbbing), 90.4%; Block 4 (sharp and stabbing), 99.1%; Block 6 (crushing and dull), 94.1%; Block 7 (twisting), 95.8%; and Block 8b (burning), 100%. There were no differences in consistency of block interpretation between sexes or in terms of past experience of pain. IMPLICATIONS: We were able to create a group of physical objects (Pain Blocks) that were consistently and persistently interpreted, with a high degree of reliability, to represent specific pain qualities across ages and sexes. Although this proof-of-concept article was limited by the inclusion of English-speaking patients only and voluntary participants not currently in pain, the results support further investigation into tools to create a shared understanding of pain sensations between provider and participant.

3.
Clin Pract Cases Emerg Med ; 3(4): 440-441, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31763612

RESUMO

A 54-year-old man presented to the emergency department with confusion and Parkinsonian features after suspected heroin snorting. He had magnetic resonance imaging of the brain demonstrating isolated symmetric bilateral globus pallidus (GP) restricted diffusion and edema consistent with hypoxic ischemic encephalopathy. In contrast to other anoxic/ischemic insults, where the GP is preferentially spared, autopsy reports on intravenous heroin users have found the GP to be specifically affected, often demonstrating symmetric bilateral lesions. Opioid toxicity should be considered in patients presenting with Parkinsonian features on examination or pallidal lesions on imaging, especially in younger adults where infarction is less common.

5.
R I Med J (2013) ; 102(6): 44-46, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398969

RESUMO

We describe a case of disulfiram-ethanol reaction in a patient presenting with altered mental status. The patient was found to be profoundly hypotensive, requiring multiple vasopressor agents. As the symptoms associated with disulfiram reaction are non-specific, it is important to maintain a high level of suspicion for drug reaction when caring for the undifferentiated altered and hypotensive patient.


Assuntos
Dissuasores de Álcool/efeitos adversos , Dissulfiram/efeitos adversos , Etanol/efeitos adversos , Hipotensão/induzido quimicamente , Dissuasores de Álcool/administração & dosagem , Dissulfiram/administração & dosagem , Etanol/administração & dosagem , Feminino , Humanos , Hipotensão/tratamento farmacológico , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Vasoconstritores/uso terapêutico , Vasopressinas/uso terapêutico
6.
R I Med J (2013) ; 102(1): 55-57, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709077

RESUMO

Cement is widely used in construction. Acute exposures with immediate sequelae have been infrequently described. This case report describes a man who developed multifocal pneumonitis with acute respiratory distress syndrome (ARDs) and respiratory failure one day after cement dust exposure. Chromium, cobalt, and nickel components in cement may cause pulmonary tissue irritation. Sand and gravel in cement may cause direct abrasive injury. Inhalation may cause direct thermal injury through an exothermic reaction. The silicon dioxide component has been shown to cause pulmonary injury through cytokine-mediated inflammation. Cement batches for smaller-scale construction jobs are often mixed onsite increasing exposure risk. Implementation of personal protective equipment has been shown to reduce respiratory symptoms among cement workers, underscoring the need for occupational health standards and further research. [Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].


Assuntos
Materiais de Construção/efeitos adversos , Poeira , Exposição por Inalação/efeitos adversos , Doenças Profissionais/fisiopatologia , Exposição Ocupacional/efeitos adversos , Pneumonia/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Antibacterianos/uso terapêutico , Materiais de Construção/análise , Poeira/análise , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/terapia , Tamanho da Partícula , Pneumonia/fisiopatologia , Pneumonia/terapia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Esteroides/uso terapêutico , Resultado do Tratamento
7.
Acad Emerg Med ; 25(3): 366-367, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29265548
8.
J Med Toxicol ; 14(1): 68-73, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29285649

RESUMO

INTRODUCTION: Non-invasive screening of carboxyhemoglobin saturation (SpCO) in the emergency department to detect occult exposure is increasingly common. The SpCO threshold to consider exposure in smokers is up to 9%. The literature supporting this cutoff is inadequate, and the impact of active smoking on SpCO saturation remains unclear. The primary objective was to characterize baseline SpCO in a cohort of smokers outdoors. Secondary objectives were to explore the impact of active smoking on SpCO and to compare SpCO between smokers and non-smokers. METHODS: This was a prospective cohort pilot study in two outdoor urban public areas in the USA, in a convenience sample of adult smokers. SpCO saturations were assessed non-invasively before, during, and 2 min after cigarette smoking with pulse CO-oximetry. Analyses included descriptive statistics, correlations, and a generalized estimating equation model. RESULTS: Eighty-five smokers had mean baseline SpCO of 2.7% (SD 2.6) and peak of 3.1% (SD 2.9), while 15 controls had SpCO 1.3% (SD 1.3). This was a significant difference. Time since last cigarette was associated with baseline SpCO, and active smoking increased mean SpCO. There was correlation among individual smokers' SpCO levels before, during, and 2 min after smoking, indicating smokers tended to maintain their baseline SpCO level. CONCLUSIONS: This study is the first to measure SpCO during active smoking in an uncontrolled environment. It suggests 80% of smokers have SpCO ≤ 5%, but potentially lends support for the current 9% as a threshold, depending on clinical context.


Assuntos
Carboxihemoglobina/análise , Fumar Cigarros/sangue , Adulto , Idoso , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/etiologia , Estudos de Coortes , Meio Ambiente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Projetos Piloto , Estudos Prospectivos , Adulto Jovem
9.
J Emerg Med ; 53(4): 520-523, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756934

RESUMO

BACKGROUND: Scopolamine is a potent anticholinergic compound used commonly for the prevention of postoperative nausea and vomiting. Scopolamine can cause atypical anticholinergic syndromes due to its prominent central antimuscarinic effects. CASE REPORT: A 47-year-old female presented to the emergency department (ED) 20 h after hospital discharge for a right-knee meniscectomy, with altered mental status (AMS) and dystonic extremity movements that began 12 h after her procedure. Her vital signs were normal and physical examination revealed mydriasis, visual hallucinations, hyperreflexia, and dystonic movements. Laboratory data, lumbar puncture, and computed tomography were unrevealing. The sustained AMS prompted a re-evaluation that revealed urinary overflow with 500 mL of retained urine discovered on ultrasound and a scopolamine patch hidden behind her ear. Her mental status improved shortly after patch removal and physostigmine, with complete resolution after 24 h with discharge diagnosis of scopolamine-induced anticholinergic toxicity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although therapeutically dosed scopolamine transdermal patches rarely cause complications, incomplete toxidromes can be insidiously common in polypharmacy settings. Providers should thoroughly evaluate the skin of intoxicated patients for additional adherent medications that may result in a delay in ED diagnosis and curative therapies. Our case, as well as rare case reports of therapeutic scopolamine-induced anticholinergic toxicity, demonstrates that peripheral anticholinergic effects, such as tachycardia, dry mucous membranes, and hyperpyrexia are often not present, and incremental doses of physostigmine may be required to reverse scopolamine's long duration of action. This further complicates identification of the anticholinergic toxidrome and diagnosis.


Assuntos
Síndrome Anticolinérgica/diagnóstico , Antagonistas Colinérgicos/envenenamento , Síndrome Anticolinérgica/etiologia , Antagonistas Colinérgicos/uso terapêutico , Distonia/etiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Alucinações/etiologia , Humanos , Meniscectomia/efeitos adversos , Meniscectomia/normas , Pessoa de Meia-Idade , Midríase/etiologia , Período Pós-Operatório , Escopolamina/envenenamento , Escopolamina/uso terapêutico , Adesivo Transdérmico
10.
Acad Emerg Med ; 24(10): 1193-1203, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28756645

RESUMO

BACKGROUND: Over 35 million alcohol-impaired (AI) patients are cared for in emergency departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol-induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients. OBJECTIVE: The objective was to evaluate a novel standardized ED assessment of alcohol impairment, Hack's Impairment Index (HII score), in a busy urban ED. METHODS: A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both "usual" and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2-5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated. RESULTS: A total of 8,074 visits from 3,219 unique patients were eligible for study, including 7,973 (98.7%) with ethanol levels, 5,061 (62.7%) with complete HII scores, and 3,646 (45.2%) with health care provider assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R2  = 0.09, 0.09, and 0.17 for high-, medium-, and low-frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients' visits. CONCLUSIONS: The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with health care provider evaluations.


Assuntos
Intoxicação Alcoólica/diagnóstico , Serviço Hospitalar de Emergência , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
11.
Am J Emerg Med ; 34(8): 1452-4, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27142757

RESUMO

CONTEXT: Intravenous lipid emulsion (ILE) is a potential antidote for severe overdose of certain lipophilic drugs. Cocaine overdose is often fatal and has no antidote. The use of ILE after cocaine-induced cardiac arrest has been suggested but is not well characterized. OBJECTIVE: The objective of the study is to determine if ILE would reverse cocaine-induced cardiac arrest in a rat model. MATERIALS AND METHODS: Twelve Sprague-Dawley rats with intra-arterial and intravenous access were sedated with isoflurane and split into 2 cocaine dose groups, then given either ILE or normal saline (NS) intravenously (IV)-group A, 7 animals received cocaine (10 mg/kg IV) with 6 of 7 given ILE (15 mg/kg IV) and 1 of 7 given NS (equal volume); group B, 5 animals received cocaine (5 mg/kg IV) with 3 of 5 given ILE (15 mg/kg IV) and 2 of 5 given NS (equal volume). Closed chest compressions were initiated for asystole and continued for 15 minutes with rhythm checks every minute. RESULTS: All 12 rats experienced cardiac arrest after cocaine bolus. Resuscitation was successful in 1 of 7 rats in group A and 0 of 5 in group B. CONCLUSIONS: Intravenous lipid emulsion administration did not affect outcome of cocaine-induced cardiac arrest compared with control in this model.


Assuntos
Emulsões Gordurosas Intravenosas/administração & dosagem , Parada Cardíaca/terapia , Ressuscitação/métodos , Animais , Cocaína/toxicidade , Modelos Animais de Doenças , Parada Cardíaca/induzido quimicamente , Masculino , Ratos , Ratos Sprague-Dawley
12.
R I Med J (2013) ; 99(1): 25-7, 2016 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-26726858

RESUMO

The incidence of poisonous snakebites has regional variance. Health care providers' knowledge and comfort in treating these envenomated patients depends on the density of poisonous snakes in their environment, with practitioners in the southern U.S. typically treating more exposed patients than those in colder regions in the North. We present a rare case of a confirmed copperhead snakebite that occurred in Rhode Island. We will review Copperhead bites, clinical management and treatment options.


Assuntos
Agkistrodon , Antivenenos/administração & dosagem , Fragmentos Fab das Imunoglobulinas/administração & dosagem , Mordeduras de Serpentes/tratamento farmacológico , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Rhode Island , Mordeduras de Serpentes/terapia
14.
15.
Am J Drug Alcohol Abuse ; 40(2): 111-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24555813

RESUMO

BACKGROUND: Emergency Departments (EDs) care for thousands of alcohol-intoxicated patients annually. No clinically relevant bedside measures currently exist to describe degree of impairment. OBJECTIVES: To assess a group of bedside tests ("Hack's Impairment Index [HII] score") that applies a numerical value to the degree of alcohol-induced impairment in ED patients. METHODS: A six-month retrospective review of HII score data was performed in a convenience sample of 293 intoxicated ED patients. Patients were scored 0-4 on five tasks, divided by the maximum score (20 if all tasks completed), every 2 hours; and classified by the number of visits: Low-frequency (1 visit); Medium-frequency (2 visits); High-frequency (≥3 visits). Correlations were assessed between HII score, healthcare provider judgment of intoxication, and measured alcohol levels. RESULTS: Study patients had 513 visits; 236 were low-frequency, 26 middle-frequency and 31 high-frequency. Clinical assessment and HII score were strongly correlated (Spearman's rho = 0.82, p << 0.001); clinical assessment and alcohol level less strongly so (rho = 0.49, p << 0.001). Among low-frequency patients, HII score and alcohol level were weakly correlated (r = 0.324, p < 0.001), with no such correlation among high-frequency visitors (r = -0.04, p = 0.89). The mean decline between serial HII scores was 0.126 (95% CI: 0.098-0.154). CONCLUSION: This pilot study shows the HII score can be performed at the bedside of alcohol-intoxicated patients. The HII declines in a reasonably predictable manner over time; and applies a quantitative, objective assessment of alcohol impairment.


Assuntos
Intoxicação Alcoólica/diagnóstico , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Ann Emerg Med ; 64(1): 32-7, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24342818

RESUMO

STUDY OBJECTIVE: We compare the effects of intravenous lipid emulsion and normal saline solution pretreatment on mortality and hemodynamic changes in a rat model of cocaine toxicity. We hypothesize that intravenous lipid emulsion will decrease mortality and hemodynamic changes caused by cocaine administration compared with saline solution. METHODS: Twenty male Sprague-Dawley rats were sedated and randomized to receive intravenous lipid emulsion or normal saline solution, followed by a 10 mg/kg bolus of intravenous cocaine. Continuous monitoring included intra-arterial blood pressure, pulse rate and ECG tracing. Endpoints included a sustained undetectable mean arterial pressure (MAP) or return to baseline MAP for 5 minutes. The log-rank test was used to compare mortality. A mixed-effect repeated-measures ANOVA was used to estimate the effects of group (intravenous lipid emulsion versus saline solution), time, and survival on change in MAP, pulse rate, or pulse pressure. RESULTS: In the normal saline solution group, 7 of 10 animals died compared with 2 of 10 in the intravenous lipid emulsion group. The survival rate of 80% (95% confidence interval 55% to 100%) for the intravenous lipid emulsion rats and 30% (95% confidence interval 0.2% to 58%) for the normal saline solution group was statistically significant (P=.045). CONCLUSION: Intravenous lipid emulsion pretreatment decreased cocaine-induced cardiovascular collapse and blunted hypotensive effects compared with normal saline solution in this rat model of acute lethal cocaine intoxication. Intravenous lipid emulsion should be investigated further as a potential adjunct in the treatment of severe cocaine toxicity.


Assuntos
Cocaína/toxicidade , Emulsões Gordurosas Intravenosas/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Eletrocardiografia , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Cloreto de Sódio/farmacologia , Taxa de Sobrevida , Fatores de Tempo
17.
Acad Emerg Med ; 20(10): 1022-5, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24127705

RESUMO

OBJECTIVES: The anticoagulant dabigatran has no reversal agent and may cause life-threatening bleeding in patients with trauma or closed-space hemorrhage. Intravenous lipid emulsion (ILE) is thought to create a lipid compartment in serum that sequesters lipophilic drugs. Dabigatran is lipophilic, and its anticoagulant effects are concentration dependent. The study objective was to determine if ILE therapy reverses dabigatran's anticoagulant effects. METHODS: Twenty rats were selected at random, 10 in the ILE group and 10 in a normal saline (NS) control group. Animals had a baseline tail bleeding time (T0), followed by oral dabigatran administration (15 mg/kg). At 45 minutes (T45), a second tail bleed time measurement was performed, followed by a 7-minute infusion of 15 mL/kg ILE or NS. A final 60-minute (T60) bleed time measurement was obtained. An ILE-only group of five animals had bleeding times assessed prior to (T0) and 15 minutes after (T15) ILE therapy. A mixed-effect repeated-measures analysis of variance modeling the effect of time, group, and the interaction of group and time on bleed times was conducted. RESULTS: There was a significant within-subject change in bleeding time across the assessment points (F(2,36) = 33; p < 0.001), but there were no effect of group (F(1,18) = 1.42, p = 0.25) or an interaction between group and assessment point on mean bleeding time (F(2,36) = 0.59, p = 56). Between T0 and T45, average bleeding times increased from 109.5 seconds (95% confidence interval [CI] = 94 to 125 seconds) to 231.8 seconds (95% CI = 193 to 271 seconds; p < 0.0001) for both the ILE group and the NS control group. Between T45 and T60, bleeding times in the ILE group decreased by 31.5 seconds (95% CI = -77 to 14 seconds) and by 6 seconds (95% CI = -67 to 55 seconds) in the NS group (p = 0.46). In the five ILE-only animals, the average bleeding time at T0 was 114 seconds (95% CI = 62 to 166 seconds), which increased significantly at T15 to 237 seconds (95% CI = 161 to 313 seconds; p = 0.02). CONCLUSIONS: The anticoagulant effects of dabigatran are not reversed with ILE therapy. Although ILE itself significantly prolonged bleeding times, when administered to dabigatran-anticoagulated rats, bleeding times did not change significantly. There may be a complex interaction of ILE with dabigatran that this study was not able to elucidate.


Assuntos
Antitrombinas/administração & dosagem , Benzimidazóis/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Emulsões Gordurosas Intravenosas/farmacologia , Hemorragia/tratamento farmacológico , beta-Alanina/análogos & derivados , Administração Oral , Animais , Tempo de Sangramento , Dabigatrana , Masculino , Ratos , Ratos Sprague-Dawley , beta-Alanina/administração & dosagem
19.
J Emerg Med ; 45(5): 797-805, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23786780

RESUMO

BACKGROUND: Hyperglycemic crisis is a metabolic emergency associated with uncontrolled diabetes mellitus that may result in significant morbidity or death. Acute interventions are required to manage hypovolemia, acidemia, hyperglycemia, electrolyte abnormalities, and precipitating causes. Despite advances in the prevention and management of diabetes, its prevalence and associated health care costs continue to increase worldwide. Hyperglycemic crisis typically requires critical care management and hospitalization and contributes to global health expenditures. OBJECTIVE: Diagnostic and resolution criteria and management strategies for diabetic ketoacidosis and hyperosmolar hyperglycemic crisis are provided. A discussion of prevalence, mortality, pathophysiology, risk factors, clinical presentation, differential diagnosis, evaluation, and management considerations for hyperglycemic crisis are included. DISCUSSION: Emergency physicians confront the most severe sequelae of uncontrolled diabetes and provide crucial, life-saving management. With ongoing efforts from diabetes societies to incorporate the latest clinical research to refine treatment guidelines, management and outcomes of hyperglycemic crisis in the emergency department continue to improve. CONCLUSION: We provide an overview of the evaluation and treatment of hyperglycemic crisis and offer a concise, targeted management algorithm to aid the practicing emergency physician.


Assuntos
Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/terapia , Hiperglicemia/diagnóstico , Hiperglicemia/terapia , Coma Hiperglicêmico Hiperosmolar não Cetótico/diagnóstico , Coma Hiperglicêmico Hiperosmolar não Cetótico/terapia , Adolescente , Adulto , Algoritmos , Bicarbonatos/uso terapêutico , Glicemia/metabolismo , Criança , Pré-Escolar , Cetoacidose Diabética/sangue , Emergências , Hidratação , Humanos , Hiperglicemia/sangue , Coma Hiperglicêmico Hiperosmolar não Cetótico/sangue , Lactente , Insulina/uso terapêutico , Potássio/sangue , Potássio/uso terapêutico , Fatores de Risco
20.
J Med Toxicol ; 9(3): 220-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23412937

RESUMO

Intravenous lipid emulsion (ILE) is an adjunctive antidote used in selected critically ill poisoned patients. These patients may also require administration of advanced cardiac life support (ACLS) drugs. Limited data is available to describe interactions of ILE with standard ACLS drugs, specifically epinephrine. Twenty rats with intra-arterial and intravenous access were sedated with isoflurane and split into ILE or normal saline (NS) pretreatment groups. All received epinephrine 15 µm/kg intravenously (IV). Continuous mean arterial pressure (MAP) and heart rate (HR) were monitored until both indices returned to baseline. Standardized t tests were used to compare peak MAP, time to peak MAP, maximum change in HR, time to maximum change in HR, and time to return to baseline MAP/HR. There was a significant difference (p = 0.023) in time to peak MAP in the ILE group (54 s, 95 % CI 44-64) versus the NS group (40 s, 95 % CI 32-48) and a significant difference (p = 0.004) in time to return to baseline MAP in ILE group (171 s, 95 % CI 148-194) versus NS group (130 s, 95 % CI 113-147). There were no significant differences in the peak change in MAP, peak change in HR, time to minimum HR, or time to return to baseline HR between groups. ILE-pretreated rats had a significant difference in MAP response to epinephrine; ILE delayed the peak effect and prolonged the duration of effect of epinephrine on MAP, but did not alter the peak increase in MAP or the HR response.


Assuntos
Suporte Vital Cardíaco Avançado , Modelos Animais de Doenças , Epinefrina/farmacologia , Emulsões Gordurosas Intravenosas/efeitos adversos , Hemodinâmica/efeitos dos fármacos , Transtornos Relacionados ao Uso de Substâncias/terapia , Vasoconstritores/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Cinética , Masculino , Nutrição Parenteral Total/efeitos adversos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
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