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1.
Medicina (Kaunas) ; 55(7)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31269687

RESUMO

Background and objectives: The etiology of anemia associated with heart failure is not fully understood, but there are data suggesting the involvement of multiple mechanisms, including various drug therapies used in patients with heart failure. Our primary objective was to evaluate the impact of beta blockers, angiotensin-converting enzyme inhibitors, and calcium-channel blockers on iron metabolism in patients with heart failure. Materials and Methods: This was a prospective observational study that included patients diagnosed with heart failure and iron deficiency (defined by ferritin <100 µg/L, or 100-300 µg/L with transferrin saturation <20%). Patients with anemia secondary to a known cause were excluded. Results: We found a statistically significant correlation between beta-blocker treatment and ferritin values (p = 0.02). Iron, hemoglobin, and hematocrit levels were significantly lower in the patients using calcium-channel blockers than those who were not. We also found a statistically significant indirect correlation (p = 0.04) between the use of angiotensin-converting enzyme inhibitors and hematocrit levels. Conclusion: The contribution of our study arises from the additional data regarding the drug-induced etiology of iron deficiency. Practitioners should be aware of the potential impact of therapeutic recommendations and this should imply a close monitoring of the biochemical parameters of iron deficiency in this category of patients.


Assuntos
Anemia/etiologia , Insuficiência Cardíaca/tratamento farmacológico , Distúrbios do Metabolismo do Ferro/etiologia , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Anemia/sangue , Anemia/complicações , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Feminino , Insuficiência Cardíaca/sangue , Humanos , Ferro/análise , Ferro/sangue , Distúrbios do Metabolismo do Ferro/sangue , Masculino , Pessoa de Meia-Idade
2.
J Int Med Res ; 47(1): 159-172, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30222016

RESUMO

OBJECTIVE: This study was performed to determine whether a dual-biomarker approach using N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and galectin-3 optimizes the diagnosis and risk stratification of acute cardiac dyspnea. Atypical clinical manifestations and overlapping pathologies require objective and effective diagnostic methods to avoid treatment delays. METHODS: This prospective observational study included 208 patients who presented to the emergency department for acute dyspnea. NT-proBNP and galectin-3 were measured upon admission. The patients were divided into two groups according to the etiology of their clinical manifestations: cardiac and non-cardiac dyspnea. The patients' New York Heart Association functional class, left ventricular ejection fraction, and discharge status were assessed. RESULTS: Diagnostic criteria for acute heart failure were fulfilled in 61.1% of the patients. NT-proBNP and galectin-3 were strongly and significantly correlated. Receiver operating characteristic analysis revealed similar areas under the curve for both markers in the entire group of patients as well as in the high-risk subsets of patients. CONCLUSIONS: The diagnostic performance of NT-proBNP and galectin-3 is comparable for both the total population and high-risk subsets. Galectin-3 adds diagnostic value to the conventional NT-proBNP in patients with acute cardiac dyspnea, and its utility is of major interest in uncertain clinical situations.


Assuntos
Dispneia/diagnóstico , Galectina 3/sangue , Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Dispneia/sangue , Dispneia/fisiopatologia , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/metabolismo , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Volume Sistólico/fisiologia
3.
Anatol J Cardiol ; 20(1): 52-59, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29952364

RESUMO

Anemia associated with heart failure is a frequent condition, which may lead to heart function deterioration by the activation of neuro-hormonal mechanisms. Therefore, a vicious circle is present in the relationship of heart failure and anemia. The consequence is reflected upon the patients' survival, quality of life, and hospital readmissions. Anemia and iron deficiency should be correctly diagnosed and treated in patients with heart failure. The etiology is multifactorial but certainly not fully understood. There is data suggesting that the following factors can cause anemia alone or in combination: iron deficiency, inflammation, erythropoietin levels, prescribed medication, hemodilution, and medullar dysfunction. There is data suggesting the association among iron deficiency, inflammation, erythropoietin levels, prescribed medication, hemodilution, and medullar dysfunction. The main pathophysiologic mechanisms, with the strongest evidence-based medicine data, are iron deficiency and inflammation. In clinical practice, the etiology of anemia needs thorough evaluation for determining the best possible therapeutic course. In this context, we must correctly treat the patients' diseases; according with the current guidelines we have now only one intravenous iron drug. This paper is focused on data about anemia in heart failure, from prevalence to optimal treatment, controversies, and challenges.


Assuntos
Anemia/terapia , Insuficiência Cardíaca/terapia , Anemia/complicações , Anemia/epidemiologia , Anemia/etiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Guias de Prática Clínica como Assunto
4.
Medicine (Baltimore) ; 96(12): e6404, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28328838

RESUMO

Acute poisoning with drugs and nonpharmaceutical agents represents an important challenge in the emergency department (ED).The objective is to create and validate a risk-prediction nomogram for use in the ED to predict the risk of in-hospital mortality in adults from acute poisoning with drugs and nonpharmaceutical agents.This was a prospective cohort study involving adults with acute poisoning from drugs and nonpharmaceutical agents admitted to a tertiary referral center for toxicology between January and December 2015 (derivation cohort) and between January and June 2016 (validation cohort). We used a program to generate nomograms based on binary logistic regression predictive models. We included variables that had significant associations with death. Using regression coefficients, we calculated scores for each variable, and estimated the event probability. Model validation was performed using bootstrap to quantify our modeling strategy and using receiver operator characteristic (ROC) analysis. The nomogram was tested on a separate validation cohort using ROC analysis and goodness-of-fit tests.Data from 315 patients aged 18 to 91 years were analyzed (n = 180 in the derivation cohort; n = 135 in the validation cohort). In the final model, the following variables were significantly associated with mortality: age, laboratory test results (lactate, potassium, MB isoenzyme of creatine kinase), electrocardiogram parameters (QTc interval), and echocardiography findings (E wave velocity deceleration time). Sex was also included to use the same model for men and women. The resulting nomogram showed excellent survival/mortality discrimination (area under the curve [AUC] 0.976, 95% confidence interval [CI] 0.954-0.998, P < 0.0001 for the derivation cohort; AUC 0.957, 95% CI 0.892-1, P < 0.0001 for the validation cohort).This nomogram provides more precise, rapid, and simple risk-analysis information for individual patients acutely exposed to drugs and nonpharmaceutical agents, and accurately estimates the probability of in-hospital death, exclusively using the results of objective tests available in the ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar , Nomogramas , Envenenamento/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise Química do Sangue , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Prognóstico , Estudos Prospectivos , Curva ROC , Características de Residência , Medição de Risco , Fatores Sexuais , Centros de Atenção Terciária , Adulto Jovem
5.
Basic Clin Pharmacol Toxicol ; 120(5): 498-504, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27883283

RESUMO

Acute poisonings represent a common cause of morbidity and mortality worldwide. The prognostic utility of the transthoracic echocardiography (TTE) parameters combined with brain natriuretic peptide (BNP) in acute poisoning with different xenobiotics, upon admission in the hospital, was not evaluated. This prospective observational cohort study included 229 acutely poisoned non-diabetic adults, with a median age of 44 years (range 18-90 years), 50.7% women, with an in-hospital mortality rate of 8.7%. Univariate logistic regression analysis showed that age, the left ventricle kinetic abnormalities, the E-wave deceleration time (EDT) and BNP correlated significantly with mortality in acutely poisoned patients. Multivariate logistic regression showed that only EDT [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.54-7.69, p 0.003], BNP (OR 1.61, 95% CI: 1.02-2.55, p 0.04) and age (OR 2.66, 95% CI: 1.23-5.76, p 0.013) are predictive for mortality. The receiver-operating characteristic (ROC) analysis proved EDT [area under the ROC curve (AUC), 0.85; CI: 0.76-0.94; p 0.001], BNP (AUC, 0.83; CI: 0.75-0.91; p 0.001) and age (AUC, 0.82; CI: 0.74-0.90; p 0.001) as indicators for fatalities. In hospitalized patients acutely intoxicated with undifferentiated poisons, EDT as a parameter of left ventricle diastolic function and BNP are useful to early predict mortality.


Assuntos
Ecocardiografia/métodos , Peptídeo Natriurético Encefálico/metabolismo , Envenenamento/mortalidade , Xenobióticos/envenenamento , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Envenenamento/fisiopatologia , Prognóstico , Estudos Prospectivos , Função Ventricular Esquerda , Adulto Jovem
6.
J Crit Care Med (Targu Mures) ; 3(4): 162-165, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29967891

RESUMO

A case of respiratory failure in a domestic fire victim presenting with 1-3-degree skin burns on 10% of the total body surface, is reported. Forty-eight hours after admission to hospital, the patient developed severe respiratory failure that did not respond to mechanical ventilation. Severe obstruction of the airway had resulted from secretions and deposits of soot forming bronchial casts. The patient required repeated bronchoscopies to separate and remove the bronchial secretions and soot deposits. An emergency bronchial endoscopic exam was crucial in the patient's survival and management. The patient was discharged from the hospital after twenty-four days.

7.
Open Med (Wars) ; 10(1): 278-284, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-28352706

RESUMO

OBJECTIVES: The objective of this study was to assess the pattern and outcome of acute cholinesterase inhibitors substances (CIS) poisoning cases, in a cohort from a regional tertiary care hospital. METHODS: cases admitted in the Toxicology Clinic of "Sf. Spiridon" Emergency Clinic Hospital Iasi, Romania between 1983 and 2013 were studied. RESULTS: a total number of 606 patients were included. The reason for exposures was intentional in 70% of cases and the commonest route of poisoning was oral in 92.2%. The highest percent of cases was females (56.4), the age group 20-29 (25.4%) and the majority (66.7%) coming from rural areas, 28.2% being agricultural workers. 36.6% of cases were severe clinical forms. Overall mortality rates were 3.8%, more than half of the death patients (65.2%) had concomitant alcohol intake. It was a significant statistical association between decrease level of serum cholinesterase on admittance and severe forms (p 0.000) and between survival and deaths groups (p 0.000). The pattern of poisoning described by our retrospective study suggests that CIS poisoning are mainly preventable. The main effective goals for prevention are restriction in free accessibility to toxic pesticides, together with sustained efforts in education concerning the life-threatening danger of pesticide poisoning.

8.
Rev Med Chir Soc Med Nat Iasi ; 118(4): 971-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25581956

RESUMO

AIM: To assess the role of butyrylcholinesterase (BuChE) activity as a predictive biomarker in acute cholinesterase inhibitor poisoning in a cohort from a regional tertiary care hospital. MATERIAL AND METHODS: Plasma butyrylcholinesterase activity on admission and at regular intervals during admission and clinical outcomes of cases admitted to the Toxicology Clinic of "Sf. Spiridon" Emergency Hospital Iasi, Romania between 1983 and 2013 were evaluated. RESULTS: A total number of 606 patients were included in the study. The mean BuChE-activity level on admission was 1.54 ml NaOH N/100. A correlation between the amount of ingested organophosphates/carbamates (OPs/CMs) and low cholinesterase activity on admission was found. 66.66% of the patients were admitted to hospital within 8 hours after poisoning. The initial, daily and mean total atropine doses administrated were 9.65 mg, 10.51 mg and 69.39 mg, respectively. 67.16% of the investigated patients received Toxogonin for 6.41 days showing a slow increase in BuChE activity afterwards. The average number of hospital days was 11.22. The study revealed that complications occurred in patients with BuChE-activity levels below 1.4 mL NaOH N/100. A positive correlation between mortality rate (3.8% of patients) and the lowest BuChE-activity level on admission (0.89 mL NaOH N/100) was found. CONCLUSIONS: BuChE activity on admission and its level during hospital stay represent an important predictive factor for acute cholinesterase inhibitors poisoning.


Assuntos
Atropina/uso terapêutico , Butirilcolinesterase/sangue , Inibidores da Colinesterase/envenenamento , Antagonistas Muscarínicos/uso terapêutico , Cloreto de Obidoxima/uso terapêutico , Intoxicação por Organofosfatos/diagnóstico , Intoxicação por Organofosfatos/tratamento farmacológico , Atropina/administração & dosagem , Biomarcadores/sangue , Inibidores da Colinesterase/sangue , Reativadores da Colinesterase/administração & dosagem , Reativadores da Colinesterase/uso terapêutico , Quimioterapia Combinada , Hospitais Universitários , Humanos , Antagonistas Muscarínicos/administração & dosagem , Cloreto de Obidoxima/administração & dosagem , Intoxicação por Organofosfatos/sangue , Intoxicação por Organofosfatos/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
9.
Int J Toxicol ; 32(5): 351-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24055824

RESUMO

The main objective of this study was to investigate whether cardiac troponin (cTn) and N-terminal, protein B-type natriuretic peptide (NT-proBNP) can be useful as indicators for amitriptyline cardiotoxicity which is a known drug having sublethal toxic cardiac effects. At the same time, this study looked at detecting potential histopathological changes specific to irreversible cardiac injuries in a rat model of amitriptyline cardiotoxicity. Male Wistar rats were randomly divided into 2 groups, control (saline) group and amitriptyline group (100 mg/kg body weight intraperitoneally, equivalent for lethal dose at 50%). Blood was collected 30 minutes after the administration. The cTn was measured using 3 different methods (2 methods designed for human use and a sandwich enzyme immunoassay specific for rat cTnT). The brain natriuretic peptide was measured by 2 different methods (1 for human and 1 specific for rats). Electrocardiography showed that the QRS complex (P < .0001) and the QT interval (P = .002) were significantly prolonged for amitriptyline-treated animals. Troponin T and NT-proBNP had significantly increased levels in all the rats but showed positive results only when using rat-specific quantitative measurement. In certain rats, the histopathological examination identified a few small foci of acute myocardial necrosis. In conclusion, elevation of cTnT and NT-proBNP are early indicators of cardiotoxicity, yet the significance of irreversible myocardial damage in amitriptyline cardiotoxicity needs to be further understood.


Assuntos
Amitriptilina/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Cardiopatias/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina T/sangue , Animais , Biomarcadores/sangue , Coração/fisiopatologia , Cardiopatias/induzido quimicamente , Cardiopatias/fisiopatologia , Síndrome do QT Longo/sangue , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/fisiopatologia , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Ratos , Ratos Wistar
10.
Hum Exp Toxicol ; 30(12): 1896-903, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21427138

RESUMO

The aim of this retrospective epidemiological study was to investigate the demographical, etiological and clinical characteristics of acute drug poisonings in Iasi County, Romania. All patients were referred and admitted in the Toxicology Clinic of "Sf. Ioan" Emergency Clinic Hospital Iasi, Romania. Between 2003 and 2009, 811 cases of acute drug poisonings were recorded, counting for 28.43% from the total number of poisonings. The majority of these poisonings resulted in mild (51.94%) and medium (28.35%) clinical forms, while 19.71% were coma situations. In all, 63.51% of patients originated from urban areas, 39.94% were unemployed and the patients were predominantly women (66.46%). A high percentage (97.27%) were suicide attempts, using only one type of drug (65.88%) and the 21-30 years group (29.8%) records the highest incidence, for both women and men. The most frequently involved drugs were benzodiazepines 13.69%, anticonvulsive drugs 8.63%, barbiturates 8.51% and cardiovascular drugs 5.92%. Drugs combinations were recorded in 32.92% of cases and 1.2% were combinations between drugs and other substances. Mortality was the outcome in 0.3% of the total registered number of acute drug poisonings. This study underlines that in order to provide a proper management of these situations, a Regional Poison Information Center is absolutely necessary.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Exposição Ambiental/efeitos adversos , Envenenamento/etiologia , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/epidemiologia , Polimedicação , Estudos Retrospectivos , Romênia/epidemiologia , Tentativa de Suicídio , Adulto Jovem
11.
Rev Med Chir Soc Med Nat Iasi ; 114(2): 359-62, 2010.
Artigo em Romano | MEDLINE | ID: mdl-20700967

RESUMO

UNLABELLED: Regarding angiotensin-converting enzyme inhibitors (ACEI) poisoning, only few data are available in the last decade literature. In the previous couple of years especially isolated case reports were published. MATERIAL AND METHOD: We analyzed retrospectively all the patients with acute ACEI poisoning admitted in Iasi Internal Medicine and Toxicology Clinic between 2004 and 2009. RESULTS: 17 cases of poisoning were recorded (enalapril-9 cases, captopril-3 cases, perindopril-3 cases, lisinopril-2 cases). All the poisonings were intentional. A favorable outcome was consistently observed, and were recorded no sequelae or death in this study. The main complain was hypotension, required fluid administration, only one case with 500 mg enalaprilum and severe hypotension required injection of vasopressive amines. No abnormal renal function and no angioedema were noted.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/envenenamento , Anti-Hipertensivos/envenenamento , Hipotensão/induzido quimicamente , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Idoso , Captopril/envenenamento , Enalapril/envenenamento , Feminino , Hidratação , Humanos , Hipotensão/terapia , Lisinopril/envenenamento , Masculino , Pessoa de Meia-Idade , Perindopril/envenenamento , Estudos Retrospectivos , Resultado do Tratamento
12.
Hum Exp Toxicol ; 29(10): 823-32, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20179021

RESUMO

Patients with Amanita phalloides-induced liver failure (LF) have a high mortality, despite significant advances in intensive care management. Our study evaluated the effect of Molecular Absorbents Recirculating System (MARS) comparative with optimal intensive care (OIC) in adults with this condition, in the absence of liver transplantation (LT). Six consecutive patients (women, range 16-61 years) affected by A. phalloides-induced LF were treated with OIC (3 patients) and MARS (3 patients). Laboratory parameters and hepeatic encephalopaty were evaluated 15 min before and 24 hours following each MARS treatment. Three 6-hour sessions per patient were performed in MARS group, with a statistically significant decrease in ammonia (p value 0.011), alaninaminotransferase (ALT) and prothrombin time (PT) (p value 0.004). Two patients had a significant rebound in bilirubin (+116%; p value 0. 04) 24 hours following MARS. Mortality in MARS group was 66.7%. Survival rate in OIC was 0%. Negative prognostic markers: lack of PT and hepatic encephalopaty improvement, rebound in bilirubin, and delay of MARS therapy initiation. No significant adverse reactions occurred during MARS. MARS is an effective depurative therapy in adults with A. phalloides-induced LF, but alone is not enough. Survival is predicted by the results of the initial MARS, amount of mushroom consumed, and time from toxin exposure.


Assuntos
Circulação Extracorpórea/métodos , Encefalopatia Hepática/terapia , Falência Hepática Aguda/terapia , Intoxicação Alimentar por Cogumelos/terapia , Desintoxicação por Sorção/métodos , Adolescente , Adulto , Amanita , Feminino , Escala de Coma de Glasgow , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/fisiopatologia , Humanos , Falência Hepática Aguda/etiologia , Pessoa de Meia-Idade , Intoxicação Alimentar por Cogumelos/complicações , Intoxicação Alimentar por Cogumelos/fisiopatologia , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento
13.
Rev Med Chir Soc Med Nat Iasi ; 113(4): 1025-33, 2009.
Artigo em Romano | MEDLINE | ID: mdl-20191869

RESUMO

UNLABELLED: Rhabdomyolysis, meaning "disintegration of striated muscle", is a potentially life-threatening syndrome resulting from release of muscular cell constituents into the circulation. The aim of this study is to determine frequence and causes of rhabomyolysis in internal medicine practice, as well as diagnostic and therapeutic discussions, based on a retrospective study in patients addressed to a medical clinic of an universitary emergency hospital. RESULTS: The most common causes of rhabdomyolysis in general practice are represented by muscular trauma, muscle enzyme deficiencies, electrolyte abnormalities, infections, drugs, toxins and endocrine disorders. Frequent encountered clinical manifestations are weakness, myalgia and tea-colored urine, and the most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration, together with specific measures (urine alkalinization, mannitol, hemodialysis).


Assuntos
Rabdomiólise/diagnóstico , Rabdomiólise/etiologia , Desequilíbrio Ácido-Base/complicações , Adulto , Intoxicação Alcoólica/complicações , Algoritmos , Biomarcadores/sangue , Doenças Transmissíveis/complicações , Creatina Quinase/sangue , Síndrome de Esmagamento/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Doenças do Sistema Endócrino/complicações , Feminino , Humanos , Incidência , Masculino , Doenças Metabólicas/complicações , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Miosite/etiologia , Estudos Retrospectivos , Rabdomiólise/enzimologia , Rabdomiólise/epidemiologia , Rabdomiólise/terapia , Fatores de Risco , Romênia/epidemiologia , Índice de Gravidade de Doença
14.
Rev Med Chir Soc Med Nat Iasi ; 111(1): 111-4, 2007.
Artigo em Romano | MEDLINE | ID: mdl-17595854

RESUMO

Respiratory arrest is a major emergency in medical practice, which implies prompt intervention from the physician assisting such case. Respiratory arrest can be classified into primary respiratory arrest, caused by airway obstruction, decreased respiratory drive, or respiratory muscle weakness and secondary respiratory arrest, as a result of circulatory insufficiency. Among important causes of respiratory arrest, acute poisonings are to remember. We present a case of respiratory arrest following intravenously self-administration of opiates in attempted suicide. Patient required rapidly orientated etiologic diagnostic, and had a favorable outcome, with complete recovery, after applying CPR protocol, as well as antidote.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Morfina/administração & dosagem , Morfina/efeitos adversos , Insuficiência Respiratória/induzido quimicamente , Adulto , Reanimação Cardiopulmonar , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Nalorfina/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Respiração Artificial , Insuficiência Respiratória/terapia , Autoadministração , Resultado do Tratamento
15.
J Gastrointestin Liver Dis ; 16(1): 109-12, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17410298

RESUMO

Caustic substances cause tissue destruction through liquefaction or coagulation reactions and the intensity of destruction depends on the type, concentration, time of contact and amount of the substance ingested. We report an unusual presentation and complication of caustic ingestion in a patient, who accidentally ingested sodium hydroxide. Our patient presented respiratory failure soon after admission and developed necrotizing esophagitis with progression to esophageal stenosis, which required surgical treatment. The complications were related to the amount of caustic soda ingested.


Assuntos
Cáusticos/efeitos adversos , Esofagite/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Hidróxido de Sódio/efeitos adversos , Idoso , Feminino , Humanos
16.
Rev Med Chir Soc Med Nat Iasi ; 111(4): 906-11, 2007.
Artigo em Romano | MEDLINE | ID: mdl-18389778

RESUMO

Cardiac complications often accompany poisoning with organophosphates. These may be serious and often fatal, being represented by cardiac arrhythmias, electrocardiographic abnormalities and conduction defects, as well as myocardial infarction, a rarely reported complication of acute pesticide poisoning. The extent and pathogenesis of cardiac toxicity from these compounds is not yet clearly defined. We report the case of a 57-year-old woman who presented to our emergency department with coma and acute non-cardiogenic pulmonary edema, as a result of organophosphates ingestion. She was resuscitated for asystole presented shortly after admission; prolonged QTc interval, ST-T changes, right bundle branch block, ventricular tachycardia were recorded. Finally she developed acute anteroseptal myocardial infarction and died despite serum cholinesterase normalization. We believe that admission in an intensive care unit, careful electrocardiographic and enzymatic monitoring of all patients is important for the diagnosis and treatment of cardiac complications of organophosphates poisoning.


Assuntos
Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Intoxicação por Organofosfatos , Bloqueio de Ramo/induzido quimicamente , Evolução Fatal , Feminino , Humanos , Síndrome do QT Longo/induzido quimicamente , Pessoa de Meia-Idade , Envenenamento/complicações , Envenenamento/fisiopatologia , Taquicardia Ventricular/induzido quimicamente
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