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2.
Emerg Med Clin North Am ; 38(4): 841-856, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981621
3.
Rev Med Suisse ; 16(693): 984-988, 2020 May 13.
Artigo em Francês | MEDLINE | ID: mdl-32401438

RESUMO

Sea bathing is often a priority activity for travelers, with widely recognized health benefits. The dangers, in contrast, are underestimated, especially in tropical seas. We describe the scope of marine envenoming, trauma, and infections, representing 1-3 % of tropical and travel medicine consultations in the literature. Our review includes the eco-epidemiology, clinical approach, and prevention of envenoming by invertebrates (jellyfish, anemone, sea-urchin, starfish, octopus, sea cone) and some vertebrates (stingrays, stone fish, snakes). We include penetrating trauma (by stingray, stonefish, sea urchin, coral) and infections (mycobacteria, marine bacteria). Eating-related dangers (ciguatera, fugu, parasites) are not described here. We also present antidotes, antivenoms, and first-aid.


Assuntos
Praias , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Infecções/epidemiologia , Infecções/terapia , Natação , Animais , Antídotos/administração & dosagem , Antídotos/uso terapêutico , Antivenenos/administração & dosagem , Antivenenos/uso terapêutico , Primeiros Socorros , Humanos , Medicina de Viagem , Doença Relacionada a Viagens
4.
Lakartidningen ; 1172020 05 25.
Artigo em Sueco | MEDLINE | ID: mdl-32453856

RESUMO

Toxicological analysis constitutes an important part of the acute treatment of poisonings. Timely laboratory results are essential for the patient to be diagnosed and treated appropriately, but also to exclude poisoning and avoid unnecessary overtreatment. Ingestion of ethylene glycol may cause acute kidney injury and, in severe cases, death, unless treated early with an antidote (ethanol infusion or fomepizole) to inhibit the formation of toxic metabolites. Diagnosis of poisoning is based on detection of ethylene glycol in plasma or serum, but a challenge remains that acute toxicology service is only available at major hospital laboratories using gas chromatography. A simple enzymatic method for the quantification of ethylene glycol (Catachem) was evaluated as a complement to currently used methods and demonstrated to provide fast and accurate measurement in a clinically relevant concentration range (1-80 mmol/l) with a minimal risk of analytical interference. The method is suitable for use on several automated clinical chemistry analyzers. Use of the enzymatic method can improve availability of acute toxicology service for ethylene glycol and contribute to better healthcare from both a patient and health resource perspective.


Assuntos
Etilenoglicol , Envenenamento , Antídotos/uso terapêutico , Etanol , Etilenoglicol/envenenamento , Fomepizol , Humanos , Envenenamento/terapia , Pirazóis
6.
J Laryngol Otol ; 134(4): 316-322, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32281535

RESUMO

BACKGROUND: Individuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy. OBJECTIVE: This paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management. METHOD: A comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019. RESULTS: Patients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined. CONCLUSION: Clinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antídotos/uso terapêutico , Epistaxe/tratamento farmacológico , Administração Oral , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Antídotos/administração & dosagem , Antitrombinas/efeitos adversos , Antitrombinas/uso terapêutico , Arginina/administração & dosagem , Arginina/análogos & derivados , Arginina/uso terapêutico , Conscientização , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Epistaxe/induzido quimicamente , Epistaxe/epidemiologia , Fator Xa/administração & dosagem , Fator Xa/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Primeiros Socorros/normas , Humanos , Masculino , Piperazinas/administração & dosagem , Piperazinas/uso terapêutico , Prevalência , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Índice de Gravidade de Doença
8.
Toxicon ; 179: 107-110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32179049

RESUMO

INTRODUCTION: Latrodectism is a rare, but potentially severe, clinical syndrome caused by spider of the genus Latrodectus. L. tredecimguttatus is widespread in Italy and its bite cause the injection of α-latrotoxin that cause depletion of acetylcholine at motor nerve endings and release of catecholamines at adrenergic nerve endings. We describe the first clinical case of L. tredecimguttatus poisoning successfully treated with L. mactans antivenom from North America. CASE REPORT: A healthy 60-year-old patient was admitted to the emergency department after unknown insect sting or arachnid/snake bite. In the early morning, the patient was working in the countryside when he felt a sting-like pain in the medial area of the right lower leg, associated with an intense burning sensation. An hour later he developed agitation, hoarseness, sweating, abdominal distress and intense pain in his right leg. In the emergency room vital signs showed a hypertensive crisis, tachycardia and peripheral oxygen desaturation. ECG was normal and ABE showed mixed acid-base disorder. Blood tests showed leukocytosis with neutrophilia, high levels of myoglobin, with normal coagulation and normal plasmatic cholinesterase. Neck, thorax and abdomen CT scan, with and without contrast medium, was negative. Four hours after admission hypertension worsened with board like rigid abdomen and onset of fasciculations, tremors, miosis and intense regional sweating. The definitive diagnosis of poisoning by L tredecimguttatus was based on the clinical picture. Within short time the antidote was provided by the Poison Centre and administered. A marked improvement of the symptomatology was noted after 30 minutes, and 1 hour later all symptoms were under control. The patient was discharged after 2 days. CONCLUSIONS: The clinical presentation of a patient suffering from latrodectism places the clinician in front of a challenging differential diagnosis. Following the suspicion, the first-line doctor is invited to discuss the case with a toxicologist, in order to confirm or exclude the diagnosis and implement all therapeutic measures. In our clinical case, the absence of organic lesions, laboratory tests not suggestive for other causes, and the presence of typical clinical feature suggested the diagnosis of L tredecimguttatus poisoning. This hypothesis was then supported by the close temporal relation between antivenom administration and symptoms improvement. With this case, we report the first use of L mactans antivenom from North America to treat L.tredecimguttatus poisoning and we confirm its effectiveness in counteracting latrodectism caused by this spider.


Assuntos
Antídotos/uso terapêutico , Viúva Negra , Picaduras de Aranhas/tratamento farmacológico , Animais , Antivenenos , Humanos , Itália
9.
PLoS One ; 15(3): e0229939, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130274

RESUMO

OBJECTIVE: This study aims to provide basic data on the types and frequency of chemical ingestions and the clinical outcomes of chemical ingestion injury. METHODS: This study retrospectively analyzed the data obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention (South Korea) from 2011 to 2016. Patients ingesting chemicals aged ≥ 18 years were included, but those ingesting unknown chemical substances or with unknown clinical outcomes were excluded. RESULTS: This study included 2,712 (47.2% were men and 52.8% were women, mean age, 47.05 years) patients ingesting chemicals. Unintentional and intentional ingestions were reported in 1,673 (61.7%) and 1,039 (38.3%), respectively. The most commonly ingested chemical substances were hypochlorites, detergents, ethanol, and acetic acid. In the unintentional ingestion group, the most common chemicals upon admission were hypochlorites (74), glacial acetic acid (60), and detergent (33). The admission rates were 60% for glacial acetic acid, 58.3% ethylene glycol, and 30.4% other alkali agents. In the intentional ingestion group, the most common chemicals upon admission were hypochlorites (242), glacial acetic acid (79), ethylene glycol (42), and detergent (41). The admission rates were 91.9% for glacial acetic acid, 87.5% ethylene glycol, 85.7% potassium cyanide, and 81.4% hydrochloric acid. In total, 79 deaths (10 unintentional ingestions, 69 intentional ingestion) were reported, and glacial acetic acid had an odds ratio of 9.299 for mortality. CONCLUSION: We compared the intentional and unintentional ingestion groups, and analyzed the factors affecting hospital admission and mortality in each group. The types and clinical outcomes of chemical ingestion varied depending on the purpose of chemical ingestion. The findings are considered beneficial in establishing treatment policies for patients ingesting chemicals.


Assuntos
Ingestão de Alimentos , Substâncias Perigosas/toxicidade , Envenenamento/epidemiologia , Ácido Acético/toxicidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antídotos/uso terapêutico , Detergentes/toxicidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Etanol/toxicidade , Etilenoglicol , Feminino , Humanos , Ácido Hipocloroso/toxicidade , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/fisiopatologia , República da Coreia/epidemiologia , Adulto Jovem
10.
Phytother Res ; 34(8): 1770-1797, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32068926

RESUMO

Garlic (Allium sativum, Liliaceae) is used widely as a spice and medicinal herb not only in its native region (Central Asia and northeastern Iran) but also all around the world. Garlic has abundance chemical compounds such as allicin, alliin, S-allyl cysteines, thiacremonone, diallyl-disulfide, diallylsulfide, and others. This medicinal plant and its constituents offer a lot of benefits including free-radical scavenging, anti-inflammatory, anticholesterolemic, anti-gastric ulcer, antimicrobial, anticancer, and antioxidant properties. Garlic also modulates the activity of several metabolizing enzymes. This review summarizes various in vitro and animal studies on the protective effects of garlic against natural and chemical toxicities. It has been shown that garlic and its major components can ameliorate the toxicity of different agents in brain, kidney, blood, liver, embryo, spleen, pancreas, heart, reproductive system in part through radical scavenging, antioxidant effect, reducing lipid peroxidation, anti-inflammatory, chelating agent, cytoprotective activities, increase protein synthesis in damaged tissues, suppressing apoptosis, modulation of p53, phosphoinositide 3-kinase, Akt, nuclear factor (erythroid-derived 2)-like 2, antioxidant responsive element, p38 MAPK, inducible nitric oxide synthase, cyclooxygenase-2, cytosolic phospholipases A2, cleaved-caspase-9, cleaved-caspase-3 Bcl-2, Bcl-2-associated X, peroxisome proliferator-activated receptor gamma, NF-jB, nuclear factor-kappaB signaling pathways and cytochrome P450 enzymes. With controlled clinical trials, garlic may be introduced as a universal antidote or protective plant against many toxic agents.


Assuntos
Antídotos/uso terapêutico , Antioxidantes/uso terapêutico , Alho/química , Animais , Antídotos/farmacologia , Antioxidantes/farmacologia , Humanos , Ratos
11.
Toxicol Lett ; 325: 67-76, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32017982

RESUMO

Racemic 3-quinuclidinyl-α-methoxydiphenylacetate (MB266) was synthesised. Its activity at muscarinic acetylcholine receptors (mAChRs), and muscle and neuronal nicotinic acetylcholine receptors (nAChRs), was compared to that of atropine and racemic 3-quinucidinyl benzilate (QNB) using a functional assay based on agonist-induced elevation of intracellular calcium ion concentration in CN21, Chinese Hamster Ovary (CHO) and SHSY5Y human cell lines. MB266 acted as an antagonist at acetylcholine receptors, displaying 18-fold selectivity for mAChR versus nAChR (compared to the 15,200-fold selectivity observed for QNB). Thus O-methylation of QNB reduced the affinity for mAChR antagonism and increased the relative potency at both muscle and neuronal nAChRs. Despite MB266 having a pharmacological profile potentially useful for the treatment of anticholinesterase poisoning, its administration did not improve the neuromuscular function in a soman-poisoned guinea-pig diaphragm preparation pretreated with the organophosphorus nerve agent soman. Consideration should be given to exploring the potential of MB266 for possible anticonvulsant action in vitro as part of a multi-targeted ligand approach.


Assuntos
Antídotos/farmacologia , Antídotos/uso terapêutico , Inibidores da Colinesterase/envenenamento , Antagonistas Muscarínicos/farmacologia , Antagonistas Muscarínicos/uso terapêutico , Agentes Neurotóxicos/envenenamento , Antagonistas Nicotínicos/farmacologia , Antagonistas Nicotínicos/uso terapêutico , Animais , Anticonvulsivantes/química , Anticonvulsivantes/uso terapêutico , Antídotos/síntese química , Células CHO , Linhagem Celular , Cricetinae , Cricetulus , Diafragma/efeitos dos fármacos , Cobaias , Humanos , Técnicas In Vitro , Masculino , Antagonistas Muscarínicos/síntese química , Músculo Esquelético/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Antagonistas Nicotínicos/síntese química , Convulsões/induzido quimicamente , Convulsões/prevenção & controle , Soman/envenenamento
12.
J Pharmacol Exp Ther ; 373(1): 51-61, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31937564

RESUMO

Bleeding resulting from the application of low-molecular-weight heparins (LMWHs) may be treated with protamine sulfate, but this treatment lacks efficiency; its action against antifactor Xa activity is limited to ∼60%. Moreover, protamine sulfate can cause life-threatening hypersensitivity reactions. We developed diblock heparin-binding copolymer (HBC), which can neutralize the anticoagulant activity of parenteral anticoagulants. In the present study, we explored the safety profile of HBC and its potential to reverse enoxaparin, nadroparin, dalteparin, and tinzaparin in human plasma and at in vivo conditions. HBC-LMWH complexes were characterized using zeta potential, isothermal titration calorimetry, and dynamic light scattering. The rat cardiomyocytes and human endothelial cells were used for the assessment of in vitro toxicity. Male Wistar rats were observed for up to 4 days after HBC administration for clinical evaluation, gross necropsy, and biochemistry and histopathological analysis. Rats were treated with LMWHs alone or followed by short-time intravenous infusion of HBC, and bleeding time and antifactor Xa activity were measured. HBC completely reversed antifactor Xa activity prolonged in vitro by all LMWHs with an optimal weight ratio of 2.5:1. The complexes of HBC-LMWHs were below 5 µm. We observed no effects on the viability of cardiovascular cells treated with HBC at concentrations up to 0.05 mg/ml. Single doses up to 20 mg/kg of HBC were well tolerated by rats. HBC completely reversed the effects of LMWHs on bleeding time and antifactor Xa activity in vivo after 20 minutes and retained ∼80% and ∼60% of reversal activity after 1 and 2 hours, respectively. Well-documented efficacy and safety of HBC both in vitro and in vivo make this polymer a promising candidate for LMWHs reversal. SIGNIFICANCE STATEMENT: Over the last decade, there has been significant progress in developing antidotes for the reversal of anticoagulants. Until now, there has been no effective and safe treatment for patients with severe bleeding under low-molecular-weight heparin therapy. Based on our in vitro and in vivo studies, heparin-binding copolymer seems to be a promising candidate for neutralizing all clinically relevant low-molecular-weight heparins.


Assuntos
Anticoagulantes/metabolismo , Antídotos/metabolismo , Hemorragia/metabolismo , Heparina de Baixo Peso Molecular/metabolismo , Animais , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Antídotos/farmacologia , Antídotos/uso terapêutico , Relação Dose-Resposta a Droga , Fator Xa/metabolismo , Hemorragia/prevenção & controle , Heparina/efeitos adversos , Heparina/metabolismo , Heparina de Baixo Peso Molecular/efeitos adversos , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Masculino , Ligação Proteica/efeitos dos fármacos , Ligação Proteica/fisiologia , Distribuição Aleatória , Ratos , Ratos Wistar
13.
Med J Aust ; 212(4): 175-183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31786822

RESUMO

INTRODUCTION: Paracetamol is a common agent taken in deliberate self-poisoning and in accidental overdose in adults and children. Paracetamol poisoning is the commonest cause of severe acute liver injury. Since the publication of the previous guidelines in 2015, several studies have changed practice. A working group of experts in the area, with representation from all Poisons Information Centres of Australia and New Zealand, were brought together to produce an updated evidence-based guidance. MAIN RECOMMENDATIONS (UNCHANGED FROM PREVIOUS GUIDELINES): The optimal management of most patients with paracetamol overdose is usually straightforward. Patients who present early should be given activated charcoal. Patients at risk of hepatotoxicity should receive intravenous acetylcysteine. The paracetamol nomogram is used to assess the need for treatment in acute immediate release paracetamol ingestions with a known time of ingestion. Cases that require different management include modified release paracetamol overdoses, large or massive overdoses, accidental liquid ingestion in children, and repeated supratherapeutic ingestions. MAJOR CHANGES IN MANAGEMENT IN THE GUIDELINES: The new guidelines recommend a two-bag acetylcysteine infusion regimen (200 mg/kg over 4 h, then 100 mg/kg over 16 h). This has similar efficacy but significantly reduced adverse reactions compared with the previous three-bag regimen. Massive paracetamol overdoses that result in high paracetamol concentrations more than double the nomogram line should be managed with an increased dose of acetylcysteine. All potentially toxic modified release paracetamol ingestions (≥ 10 g or ≥ 200 mg/kg, whichever is less) should receive a full course of acetylcysteine. Patients ingesting ≥ 30 g or ≥ 500 mg/kg should receive increased doses of acetylcysteine.


Assuntos
Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Analgésicos não Entorpecentes/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Overdose de Drogas/terapia , Administração Intravenosa , Antídotos/uso terapêutico , Austrália , Carvão Vegetal/uso terapêutico , Humanos , Nova Zelândia , Guias de Prática Clínica como Assunto
14.
Clin Toxicol (Phila) ; 58(1): 29-35, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31008657

RESUMO

Background: Cyanide is a metabolic poison used in multiple industries and is a high threat chemical agent. Current antidotes require intravenous administration, limiting their usefulness in a mass casualty scenario. Sodium tetrathionate reacts directly with cyanide yielding thiosulfate and the non-toxic compound thiocyanate. Thiosulfate, in turn, neutralizes a second molecule of cyanide, thus, per mole, sodium tetrathionate neutralizes two moles of cyanide. Historical studies examined its efficacy as a cyanide antidote, but it has not been evaluated in a clinically relevant, large animal model, nor has it previously been administered by intramuscular injection.Objective: The objective of this study is to evaluate the efficacy of intramuscular sodium tetrathionate on survival and clinical outcomes in a large, swine model of severe cyanide toxicity.Methods: Anesthetized swine were instrumented for continuous monitoring of hemodynamics, then acclimated and breathing spontaneously prior to potassium cyanide infusion (0.17 mg/kg/min). At 6-min post-apnea (no breaths for 20 s), the cyanide infusion was terminated, and animals were treated with sodium tetrathionate (∼18 mg/kg) or normal saline control. Clinical parameters and laboratory values were evaluated at various time points until death or termination of the experiment (90 min post-treatment).Results: Laboratory values, vital signs, and time to apnea were similar in both groups at baseline and treatment. Survival in the sodium tetrathionate treated group was 100% and 17% in controls (p = 0.0043). All animals treated with sodium tetrathionate returned to breathing at a mean time of 10.85 min after antidote, and all but one control remained apneic through end of the experiment. Animals treated with tetrathionate showed improvement in blood lactate (p ≤ 0.002) starting at 30 min post-treatment. The average time to death in the control group is 63.3 ± 23.2 min. No systemic or localized adverse effects of intramuscular administration of sodium tetrathionate were observed.Conclusion: Sodium tetrathionate significantly improves survival and clinical outcomes in a large, swine model of acute cyanide poisoning.


Assuntos
Antídotos/uso terapêutico , Cianetos/toxicidade , Ácido Tetratiônico/uso terapêutico , Animais , Antídotos/administração & dosagem , Cianetos/antagonistas & inibidores , Modelos Animais de Doenças , Feminino , Injeções Intramusculares , Suínos , Ácido Tetratiônico/administração & dosagem
15.
BMJ Case Rep ; 12(11)2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31753823

RESUMO

A 54-year-old man with a history of schizophrenia presented to the emergency room for weakness with associated lacrimosis, drooling, nausea, emesis, diarrhoea, diplopia and burning sensation on his skin that began 6 hours after spraying five cans of Raid on his carpet. He was noted to have miotic pupils and hyperactive bowel sounds. Given the clinical presentation, the patient was diagnosed with organophosphate (OP) toxicity. After being admitted, he developed symptoms associated with his OP toxicity and was successfully treated with atropine and pralidoxime. Most Raid products contain pyrethroids; however, both OPs and pyrethroids are available in commercial pesticides and patients may misidentify ingestions. There are limited data reporting the toxicity of pyrethroid overdose in humans and to guide its subsequent treatment. It is crucial to keep a low threshold for diagnosing and treating patients with acute onset of symptoms suspicious for an OP or pyrethroid toxidrome.


Assuntos
Produtos Domésticos/envenenamento , Inseticidas/envenenamento , Intoxicação por Organofosfatos/diagnóstico , Piretrinas/envenenamento , Antídotos/uso terapêutico , Atropina/uso terapêutico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação por Organofosfatos/tratamento farmacológico , Compostos de Pralidoxima/uso terapêutico
16.
Lakartidningen ; 1162019 Nov 01.
Artigo em Sueco | MEDLINE | ID: mdl-31688944

RESUMO

Since the late 1970s N-acetylcystein has been used as an antidote after paracetamol intoxication. The treatment is traditionally given as three consecutive infusions for 20 hours and 15 minutes. The total dose given is 300 mg/kg. Half of this amount is given as a bolus during the first 15 minutes of treatment.  This regime has proven very efficient in avoiding liver injury. However, side effects, caused by histamine release, are common (10-15%). Symptoms as flush, urticaria and, in rare cases, bronchospasm, angioedema and circulatory shock typically appear during the bolus dose and may lead to interrupted and inadequate treatment. In addition, the regime is complicated leading to a risk of administration errors. During the last years several publications have described the use of a model with two infusions instead of three. The first and the second infusions are merged and given over four hours. The third infusion and the total dose are left unchanged. This modified regime has been shown to reduce side effects and seems not to increase the risk of liver injury. As of November 1, 2019, the Swedish Poisons Information Centre will change its recommendations to the new two-infusion protocol.


Assuntos
Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Antídotos/administração & dosagem , Overdose de Drogas/tratamento farmacológico , Envenenamento/tratamento farmacológico , Acetilcisteína/efeitos adversos , Acetilcisteína/uso terapêutico , Administração Intravenosa , Antídotos/efeitos adversos , Antídotos/uso terapêutico , Humanos , Centros de Controle de Intoxicações , Guias de Prática Clínica como Assunto
17.
Lakartidningen ; 1162019 Sep 25.
Artigo em Sueco | MEDLINE | ID: mdl-31573667

RESUMO

Sometimes it is suspected that people have been involuntary exposed to drugs, usually by spiked drinks. A young woman was transported to an emergency department by ambulance. Her clinical symptoms (decreased consciousness, mydriasis, confusion, hallucinations and urine retention) indicated anticholinergic syndrome that was effectively treated with the antidote physostigmine. A urine sample tested negative for common narcotic drugs and alcohol, but an extended toxicological analysis of the urine revealed the presence of the alkaloid scopolamine. Scopolamine occurs naturally in Solanaceae plants and is used in some medications. The woman reported that the symptoms had appeared soon after she was offered tea by a male acquaintance. The analytical results along with the woman's story indicated that she had been subjected to a drug-facilitated crime. The results further demonstrate that in suspected cases of involuntary drug exposure, testing should cover a wide panel of relevant drugs, otherwise poisoning may be missed.


Assuntos
Antagonistas Colinérgicos , Escopolamina , Detecção do Abuso de Substâncias , Adolescente , Adulto , Síndrome Anticolinérgica/tratamento farmacológico , Síndrome Anticolinérgica/etiologia , Antídotos/uso terapêutico , Antagonistas Colinérgicos/envenenamento , Antagonistas Colinérgicos/urina , Cromatografia Líquida de Alta Pressão , Vítimas de Crime , Feminino , Humanos , Espectrometria de Massas , Fisostigmina/uso terapêutico , Escopolamina/envenenamento , Escopolamina/urina , Detecção do Abuso de Substâncias/métodos , Detecção do Abuso de Substâncias/normas , Adulto Jovem
18.
Drug Res (Stuttg) ; 69(11): 583-597, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31390663

RESUMO

In the case of nuclear incidents, radioiodine may be liberated. After incorporation it accumulates in the thyroid and by internal irradiation enhances the risk of cancer occurrence. By administering a large dose of non-radioactive iodine the uptake of radioiodine into the gland can be inhibited ("iodine blockade"). Biokinetic models using first order kinetics are not suited to simulate iodine blockade, as the uptake into the gland is mediated by a saturable active transport. Therefore, we integrated an uptake mechanism described by a Michaelis-Menten kinetic into a simple ICRP biokinetic model. We moreover added a total uptake blocking mechanism representing the Wolff-Chaikoff effect becoming active when the gland is saturated with iodine. The validity of the model was ascertained by comparison with IMBA software. The competition of radioiodine and stable iodine at the membrane carrier site was modeled according to the rate law for monomolecular reactions for competing substrates. Our simulations show that competition for the uptake at the membrane carrier site accounts for about 60% and the saturation of the gland with iodine for over 35% of the total protective efficacy that exceeds 95%. Following acute radioiodine exposure, it is preferable to administer a single large dose of stable iodine. In the case of continuous radioiodine exposure, a single dose of stable iodine is less effective than after an acute exposure and splitting the total available dose and shortening the dosage intervals enhance efficacy. Model-based simulations may be a useful tool to develop antidote dosage schemes for uncommon emergencies.


Assuntos
Antídotos/uso terapêutico , Radioisótopos do Iodo/efeitos adversos , Iodo/efeitos adversos , Humanos , Cinética , Modelos Biológicos , Radiometria/métodos , Glândula Tireoide/efeitos dos fármacos
19.
Lakartidningen ; 1162019 Jul 29.
Artigo em Sueco | MEDLINE | ID: mdl-31361324

RESUMO

Toxicological analysis is an important part of the acute treatment of various intoxications. Rapid laboratory responses are important for the patient to be assessed and treated correctly, and also to exclude poisoning and thus avoid unjustified and costly overtreatment. In Sweden, paracetamol (acetaminophen) is one of the most common pharmaceuticals in drug poisoning. Paracetamol overdose can cause severe liver damage unless treated early with the antidote acetylcysteine. A nation-wide initiative for improved laboratory measurement of paracetamol in plasma/serum samples has resulted in a marked reduction in the inter-laboratory coefficient of variation to generally below 10%. The introduction of a harmonized national reporting range for plasma/serum paracetamol covering at least 50-5 000 µmol/l was also recommended. This initiative will hopefully contribute to better healthcare from both a patient and health resource perspective in cases of paracetamol poisoning.


Assuntos
Acetaminofen , Analgésicos não Entorpecentes , Serviços de Laboratório Clínico/normas , Acetaminofen/sangue , Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Acetilcisteína/uso terapêutico , Analgésicos não Entorpecentes/sangue , Analgésicos não Entorpecentes/envenenamento , Antídotos/administração & dosagem , Antídotos/uso terapêutico , Overdose de Drogas/diagnóstico , Overdose de Drogas/tratamento farmacológico , Humanos , Envenenamento/diagnóstico , Envenenamento/tratamento farmacológico , Guias de Prática Clínica como Assunto , Suécia , Fatores de Tempo
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