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1.
Ann Saudi Med ; 39(4): 279-282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31381360

RESUMO

A 28-month-old boy mistakenly received intranasal atropine sulfate instead of Otrivin (xylometazoline hydrochloride) for the treatment of adenoid hypertrophy. Later on, he came to the emergency department with anticholinergic manifestations after the administration of multiple drops. The child presented with a tonic-clonic seizure lasting for a few minutes, followed by a brief loss of consciousness, vomiting, agitation, and irritability, all of which were stabilized by a dose of intravenous lorazepam. Subsequently, he was admitted to the pediatric intensive care unit for observation. Afterwards, he developed agitation and unsteady gait, both of which resolved after receiving neostigmine. Eventually, the child became asymptomatic and was discharged home. To the best of our knowledge, only one similar case has been reported in the literature. SIMILAR CASES PUBLISHED: 1.


Assuntos
Atropina/envenenamento , Erros de Medicação , Antagonistas Muscarínicos/envenenamento , Administração Intranasal , Atropina/administração & dosagem , Pré-Escolar , Serviço Hospitalar de Emergência , Humanos , Imidazóis/administração & dosagem , Lorazepam/administração & dosagem , Masculino , Antagonistas Muscarínicos/administração & dosagem
3.
BMJ Case Rep ; 20152015 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-26543025

RESUMO

There is an increasing use of herbal remedies and medicines, with a commonly held belief that natural substances are safe. We present the case of a 50-year-old woman who was a trained herbalist and had purchased an 'Atropa belladonna (deadly nightshade) preparation'. Attempting to combat her insomnia, late one evening she deliberately ingested a small portion of this, approximately 50 mL. Unintentionally, this was equivalent to a very large (15 mg) dose of atropine and she presented in an acute anticholinergic syndrome (confused, tachycardic and hypertensive) to our accident and emergency department. She received supportive management in our intensive treatment unit including mechanical ventilation. Fortunately, there were no long-term sequelae from this episode. However, this dramatic clinical presentation does highlight the potential dangers posed by herbal remedies. Furthermore, this case provides clinicians with an important insight into potentially dangerous products available legally within the UK. To help clinicians' understanding of this our discussion explains the manufacture and 'dosing' of the A. belladonna preparation.


Assuntos
Atropa belladonna/envenenamento , Overdose de Drogas/terapia , Fitoterapia/efeitos adversos , Intoxicação por Plantas/diagnóstico , Preparações de Plantas/envenenamento , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Atropina/envenenamento , Confusão/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade , Intoxicação por Plantas/terapia , Plantas Tóxicas/envenenamento , Taquicardia/induzido quimicamente , Resultado do Tratamento
4.
J Forensic Sci ; 59(3): 859-64, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24502541

RESUMO

In March 2009, the body of a 51-year-old man was found in the boot of his car. The body had been frozen before being dismembered at the abdomen. The autopsy failed to determine the cause of death. Systematic toxicological analyses of the victim's peripheral blood and urine showed the presence of atropine, a powerful anticholinergic. Atropine was therefore specifically detected and quantified throughout the victim's biologic samples by HPLC-MS² in the biologic fluids and UHPLC-MS² in the hair. The atropine concentrations were 887 ng/mL in the cardiac blood, 489 ng/mL in the peripheral blood, 6693 ng/mL in the gastric contents (1.1 µg), 6753 ng/mL in the urine, and 2290 pg/mg in the hair. The blood concentrations measured in the decedent were consistent with an overdose of atropine, which was determined as the cause of death. The manner of death was a homicide with criminal intent.


Assuntos
Atropina/envenenamento , Homicídio , Antagonistas Muscarínicos/envenenamento , Soluções Oftálmicas , Atropina/análise , Atropina/farmacocinética , Cromatografia Líquida de Alta Pressão , Toxicologia Forense , Conteúdo Gastrointestinal/química , Cabelo/química , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/análise , Antagonistas Muscarínicos/farmacocinética , Mudanças Depois da Morte , Espectrometria de Massas em Tandem , Distribuição Tecidual
5.
Pan Afr Med J ; 11: 72, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22655106

RESUMO

Atropa belladonna is a poisonous plant also called deadly nightshade. Its roots, leaves and fruits contain alkaloids: atropine, hyocyamine and scopolamine. The risk of poisoning in children is important because of possible confusion with other berries. Atropa belladonna acute intoxication is a severe condition, it's should be considered in the presence of anti-cholinergic toxidrome, the differential diagnosis include other plants or psychoactive drugs containing atropine. The treatment is mainly symptomatic including gastrointestinal decontamination with activated charcoal. In severe cases, physostigmine can be used as an antidote. We report the case of 11 year old girl with Atropa belladonna poisoning which was administrated in a therapeutic purpose as a remedy to jaundice. The child presented essentially a central anti-cholinergic syndrome. She was admitted in the intensive care unit, the progression was favorable with symptomatic treatment.


Assuntos
Atropa belladonna/envenenamento , Intoxicação por Plantas/diagnóstico , Atropa belladonna/fisiologia , Atropina/envenenamento , Criança , Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/envenenamento , Antagonistas Colinérgicos/uso terapêutico , Feminino , Humanos , Icterícia/complicações , Icterícia/tratamento farmacológico , Intoxicação por Plantas/etiologia , Plantas Tóxicas/envenenamento
6.
Rev Neurol (Paris) ; 168(5): 450-3, 2012 May.
Artigo em Francês | MEDLINE | ID: mdl-22340863

RESUMO

INTRODUCTION: Atropine is a strong antagonist of muscarinic receptors widely used in various diseases because of its anticholinergic action. CASE-REPORT: We report here a case of accidental poisoning due to ingestion of atropine eyes drops that caused severe neurologic disorders mimicking an acute stroke. Correct diagnosis was finally made by detecting atropine in the cerebrospinal fluid of the patient. CONCLUSIONS: Atropinic poisoning can induce misleading neuropsychiatric disorders mimicking stroke. Therefore, this diagnosis should be considered in patients presenting an unexplained encephalopathy with anticholinergic manifestations, especially when bilateral mydriasis occurs.


Assuntos
Atropina/envenenamento , Síndromes Neurotóxicas/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Antagonistas Muscarínicos/envenenamento , Midriáticos/envenenamento , Síndromes Neurotóxicas/etiologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia , Adulto Jovem
8.
Eur J Radiol ; 79(3): 432-6, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20395092

RESUMO

PURPOSE: Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children. METHODS: Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5mg and atropine 0.025 mg. These patients were referred to our hospital within 24h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed. RESULTS: These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up. CONCLUSION: In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment.


Assuntos
Atropina/envenenamento , Difenoxilato/envenenamento , Imagem por Ressonância Magnética/métodos , Síndromes Neurotóxicas/diagnóstico , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
9.
Hum Exp Toxicol ; 29(9): 789-91, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20164159

RESUMO

Although the multi-component weight loss supplement Redotex is banned in the United States, the supplement can be obtained in Mexico. The intent of this report was to describe the pattern of Redotex calls received by a statewide poison center system. Cases were all Redotex calls received by Texas poison centers during 2000-2008. The distribution of total calls and those involving ingestion of the supplement were determined for selected demographic and clinical factors. Of 34 total Redotex calls received, 55.9% came from the 14 Texas counties that border Mexico. Of the 22 reported Redotex ingestions, 77.3% of the patients were female and 45.5% 20 years or more. Of the 17 ingestions involving no co-ingestants, 52.9% were already at or en route to a health care facility, 41.2% were managed on site, and 5.9% was referred to a health care facility. The final medical outcome was no effect in 23.5% cases, minor effect in 5.9%, moderate effect in 11.8%, not followed but minimal clinical effects possible in 47.1%, and unable to follow but judged to be potentially toxic in 11.8%. Most Redotex calls to the Texas poison center system originated from counties bordering Mexico.


Assuntos
Fármacos Antiobesidade/envenenamento , Atropina/envenenamento , Diazepam/envenenamento , Suplementos Nutricionais/envenenamento , Emodina/análogos & derivados , Fenilpropanolamina/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Tri-Iodotironina/envenenamento , Distribuição por Idade , Combinação de Medicamentos , Emodina/envenenamento , Feminino , Humanos , Masculino , Envenenamento/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Texas/epidemiologia , Estados Unidos , United States Food and Drug Administration
10.
Clin Toxicol (Phila) ; 48(2): 143-5, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20136480

RESUMO

BACKGROUND: Anticholinergic plants contain a variety of alkaloids that are toxic if ingested. Datura innoxia belongs to the family of Solanaceae and contains two main toxic alkaloids, atropine and scopolamine. CASE SERIES: In this study we report the case series of seven individuals who were admitted to two different hospitals of Athens with an anticholinergic syndrome. All symptoms manifested after consumption of cooked vegetables (blites). INVESTIGATION: The investigation of the cases revealed that among the vegetables there was also Datura innoxia, which has a similar appearance to blites. Urine and plasma samples of the seven patients, as well as a sample of cooked vegetables, were analyzed with gas chromatography-mass spectrometry. Atropine and scopolamine were confirmed in all urine and vegetable samples, but not in plasma probably because of the delay in sample collection. The urine samples of all patients contained atropine in concentrations between 67.1 and 691.7 ng/mL, while urine concentrations of scopolamine ranged from 32.4 to 186.4 ng/mL. The concentrations of atropine and scopolamine in the cooked vegetables were found to be 0.8 and 1.2 microg/g, respectively. CONCLUSION: All patients recovered completely, although some required mechanical ventilation. The investigation and the presentation of this case series illustrate not only mass intoxication with D. innoxia, but also the utility of analytical toxicology. It also illustrates the dangers of collection of vegetables in the wild.


Assuntos
Datura/envenenamento , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/etiologia , Intoxicação por Plantas/etiologia , Atropina/farmacocinética , Atropina/envenenamento , Datura/química , Feminino , Doenças Transmitidas por Alimentos/fisiopatologia , Cromatografia Gasosa-Espectrometria de Massas , Grécia/epidemiologia , Humanos , Masculino , Intoxicação por Plantas/fisiopatologia , Escopolamina/farmacocinética , Escopolamina/envenenamento , Verduras/normas
12.
Clin Toxicol (Phila) ; 47(6): 602-4, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19586361

RESUMO

BACKGROUND: Ingestion of toxic plant constituents still poses a challenge in clinical management. The amount of berries ingested is often unclear and in the case of Atropa belladonna may affect clinical outcome. Plasma levels of atropine may thus be useful in confirming the cause of intoxication. CASE REPORT: A 48-year-old man had ingested three handfuls of Atropa belladonna. Within 6 h he experienced phases of disorientation, aggressiveness, and tachycardia. He was initially treated with diazepam, an intravenous infusion of physostigmine and activated charcoal. After temporary improvement his clinical condition worsened and he was transferred to our toxicological intensive care unit. Here, ongoing sedation and continuous administration of physostigmine was necessary because of disorientation. In the early phase of hospitalization, a blood sample was taken and a muscarinic receptor total binding equivalent to binding of 130 microg/L atropine was determined by a radio receptor technique. Within 2 days the patient recovered completely and was discharged in a good general condition. CONCLUSION: Receptor binding may help confirm diagnosis and elucidate mechanisms in this type of exposure.


Assuntos
Atropa belladonna/envenenamento , Atropina/envenenamento , Intoxicação por Plantas/etiologia , Plantas Tóxicas/envenenamento , Agressão/efeitos dos fármacos , Antídotos/administração & dosagem , Atropa belladonna/metabolismo , Atropina/sangue , Inibidores da Colinesterase/administração & dosagem , Confusão/tratamento farmacológico , Confusão/etiologia , Confusão/fisiopatologia , Diazepam/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Fisostigmina/administração & dosagem , Intoxicação por Plantas/metabolismo , Intoxicação por Plantas/fisiopatologia , Receptores Muscarínicos/metabolismo , Taquicardia/tratamento farmacológico , Resultado do Tratamento
13.
Eur J Ophthalmol ; 19(1): 170-2, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19123171

RESUMO

PURPOSE: To report the first case in the ophthalmic literature of acute anticholinergic syndrome after ingestion of Atropa belladonna mistaken for blueberries. METHODS: A 36-year-old woman presented to our ophthalmic emergency department with complaints of blurry vision, lightning flashes, disorientation, loss of balance, agitation, and anxiety for 24 hours. Ophthalmic examination revealed bilateral pupillary dilatation and paresis of accommodation. Additional symptoms of the anticholinergic syndrome were elicited on further questioning. RESULTS: Anticholinergic intoxication was suspected and the patient admitted to have eaten six "blueberries" found in the forest the previous day. The patient identified Atropa belladonna as the source of the berries she had eaten when shown photographs of the plant and its fruit. The recommendations of the Swiss Toxicological Information Centre were followed and physostigmine, the antidote for severe poisoning when 10 or more berries are ingested, was not administered. CONCLUSIONS: Accidental ingestion of Atropa belladonna berries may cause patients to first consult an ophthalmologist. It is important to recognize the anticholinergic syndrome caused by such intoxication in order to make a proper diagnosis, avoid unnecessary testing, and provide expedient appropriate treatment when required.


Assuntos
Atropa belladonna/envenenamento , Atropina/envenenamento , Antagonistas Muscarínicos/envenenamento , Midríase/etiologia , Intoxicação por Plantas/etiologia , Transtornos da Visão/etiologia , Doença Aguda , Adulto , Mirtilos Azuis (Planta) , Confusão/diagnóstico , Confusão/etiologia , Confusão/fisiopatologia , Feminino , Frutas , Humanos , Midríase/diagnóstico , Midríase/fisiopatologia , Intoxicação por Plantas/diagnóstico , Intoxicação por Plantas/fisiopatologia , Equilíbrio Postural , Pupila , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/etiologia , Transtornos das Sensações/fisiopatologia , Síndrome , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia
14.
J Emerg Med ; 34(4): 397-400, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-17931821

RESUMO

Atropine autoinjectors are used by the U.S. military as pre-hospital first-line therapy for nerve agent exposure. This case report examines the misuse of these devices in a suicide attempt. An anticholinergic toxidrome resulted from this misuse. The patient was successfully treated.


Assuntos
Atropina/administração & dosagem , Antagonistas Colinérgicos/uso terapêutico , Tentativa de Suicídio , Adulto , Atropina/envenenamento , Equipamentos e Provisões , Feminino , Humanos , Autoadministração , Estresse Psicológico
15.
J Emerg Med ; 34(1): 71-5, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17976801

RESUMO

Lomotil (Pfizer Inc., New York, NY) (diphenoxylate-atropine) is said to be potentially toxic to toddlers with exposure to as little as one to two tablets. A review of the data on diphenoxylate-atropine poisonings from the American Association of Poison Control Centers annual reports, review articles, and case series disputes this view. Fatalities associated with diphenoxylate-atropine have been reported in toddlers after repetitive or incorrect dosages. Fortunately, trends in pediatric diphenoxylate-atropine ingestions are decreasing. We review the management, trends, and current concepts regarding pediatric diphenoxylate-atropine ingestions.


Assuntos
Atropina/envenenamento , Difenoxilato/envenenamento , Fármacos Gastrointestinais/envenenamento , Atropina/administração & dosagem , Pré-Escolar , Difenoxilato/administração & dosagem , Combinação de Medicamentos , Fármacos Gastrointestinais/administração & dosagem , Humanos , Lactente , Masculino , Envenenamento/epidemiologia , Envenenamento/mortalidade , Envenenamento/terapia , Estados Unidos/epidemiologia
16.
J R Coll Physicians Edinb ; 37(1): 77-84, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17575737

RESUMO

The Deadly Nightshade, Atropa belladonna, is a plant surrounded by myth, fear and awe. In antiquity, the Greeks and the Romans knew that it contained a deadly poison. In medieval times, it was widely used by witches, sorcerors and professional poisoners. Linnaeus later codified its remarkable properties as the genus Atropa, the Fate that slits the thin spun life and the species belladonna because of its power to dilate the pupils. In the 1830s, the pure alkaloid I-atropine was isolated from the plant. This proved to be a significant tool in the study of the autonomic nervous system leading to the identification of acetylcholine as an important neurotransmitter in mammals. When pure atropine became available, it caused a large number of deaths, whether by accident, suicide or homicide.


Assuntos
Atropa belladonna , Atropina/história , Mitologia , Atropina/isolamento & purificação , Atropina/envenenamento , História do Século XIX , História do Século XX , Humanos
17.
Rinsho Byori ; 54(10): 1003-7, 2006 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-17133988

RESUMO

We encountered a patient in a restless excitable state after eating boiled jimson weed grown in the patient's garden. The patient mistook the weed for Angelica keiskei. Pupillary dilation (7/7mm), weak light reflex, body temperature of 37 degrees C, respiratory frequency of 19/min, blood pressure of 138/88 mmHg, pulse rate of 108/min, and hot feeling were observed. No abnormalities nor special findings were detected by general examination of the peripheral blood, biochemical examination of the blood, general examination of the urine, or electrocardiography. Atropine and scopolamine, which are tropane alkaloids, were detected by the GC/MS. The retention time of atropine-TMS was 17.0 min, and the mass spectra were m/z 124, 82, and 140. The retention time of scopolamine-TMS was 17.7 min, and the mass spectra were m/z 138, 108, 154 and 375. At the time of consultation, the serum concentrations of atropine and scopolamine were 31.3 ng/ml, and 30.6 ng/ml, respectively, and decreased to 6.7 ng/ml and 8.5 ng/ml, respectively, after 2 hours. The patient underwent injection of activated carbon after gastrolavage with 2,000 ml warm water, and neostigmine was administered. The patient awoke the following morning, and was discharged with mild pupillary dilation 2 days after poisoning.


Assuntos
Atropina/análise , Atropina/envenenamento , Datura stramonium/envenenamento , Escopolamina/análise , Escopolamina/envenenamento , Adulto , Atropina/sangue , Atropina/urina , Carvão Vegetal/administração & dosagem , Datura stramonium/química , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Lavagem Gástrica , Conteúdo Gastrointestinal/química , Humanos , Escopolamina/sangue , Escopolamina/urina
18.
Toxicol Rev ; 25(2): 99-138, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16958557

RESUMO

Mid-19th century European visitors to Old Calabar, an eastern province of Nigeria, could not avoid becoming aware of native belief in the power of the seeds of a local plant to determine whether individuals were innocent or guilty of some serious misdemeanour. The seeds were those of a previously unknown legume and soon referred to as the ordeal bean of Old Calabar. Their administration was known locally as 'chop nut'. Missionaries who arrived in Calabar in 1846 estimated that chop nut caused some 120 deaths annually and documented the course of poisoning. The latter information and samples of the beans rapidly found their way to Scotland, the home of the missionaries' parent church, explaining why the early toxicology of physostigmine, quantitatively the most important of three active alkaloids in the beans, has such strong Scottish, predominantly Edinburgh, associations. However, it was 1855 before the first of many medical scientists, Robert Christison, a toxicologist of repute, investigated the effects of the beans to the extent of eating part of one himself and documenting the moderate, if not severe, consequences. A further 6 years were to pass before Balfour's comprehensive botanical description of the bean plant appeared. It was he who named it Physostigma venenosum. It was not so long until the next event, one that sparked more intensive and international interest in the beans. In 1863 a young Edinburgh ophthalmologist, Argyll Robertson, published a paper announcing the arrival of the first agent that constricted the pupil of the eye. The drug was an extract of Calabar beans and Argyll Robertson openly admitted that he had been alerted to its unusual property by his physician friend, Thomas Fraser. A minor flood of contributions on the ophthalmic uses of bean extracts followed in the medical press in the next few months; those on their systemic toxicity were fewer. Fraser's MD thesis, submitted to the University of Edinburgh in 1862 and clearly pre-dating Argyll Robertson's involvement with the beans, became generally available a few weeks after the appearance of Argyll Robertson's paper and was the first to address in detail the features of systemic administration of extracts of the beans. A major problem facing all early researchers of the beans was that of deciding how best to extract their active principle, a task made all the more difficult because bioassays were the only means of determining if the toxin was being tracked. The stability of extracts was an inevitable issue and the active principle finally became known as physostigma or physostigmine, after the botanical name of the parent plant. The features of physostigmine toxicity were soon exhaustively documented, both in animals and humans. How they were mediated was another matter altogether. Fraser maintained that muscular paralysis, the cardinal feature, was the result of depression of the spinal cord and was generally, but far from unanimously, supported. Of those who had reservations, Harley was the most prominent. He concluded that paralysis was secondary to effects on the motor nerve endings and, in so doing, came nearest to present-day knowledge at a time when acetylcholine, cholinesterases and cholinesterase inhibitors were not even imagined. Differences of opinion on the mode of action of the beans were to be expected and it is hardly surprising that they were not resolved. No standard formulation of physostigmine was available so the potency of those used would have varied from one investigator to another, the range of animals experimented upon was large while the number used by any researcher was commonly in single figures, more readily available cold-blooded creatures seemed less sensitive to physostigmine toxicity than warm-blooded ones and only Fraser determinedly pursued an answer; in general, the others made one foray into bean research then turned their attentions elsewhere. The same problems would beset other aspects of bean research. While Fraser did not get as close to the mode of action of physostigmine as Harley, he reigns supreme when it comes to antagonism between physostigmine and atropine. By this time, the 1870s had dawned and although the concept of antagonism between therapeutic agents was not new, it had little, if any, reliable scientific foundation. This was about to change; antagonism was becoming exciting and rational. Fraser's firm belief that physostigmine and atropine were mutually antagonistic at a physiological level was contrary to the conventional wisdom of his contemporaries. This alone would earn him a place in history but his contribution goes much, much further. Unlike any other at the time, he investigated it with scientific rigour, experimenting on only one species, ensuring as best he could the animals were the same weight, adjusting the doses of drugs he gave them for bodyweight, determining the minimum lethal dose of each drug before assessing their antagonistic effects, adopting a single, incontrovertible endpoint for efficacy and carrying out sufficient numbers of experiments to appear convincing in a later era where the statistical power of studies is all-important. To crown it all, he presented his results graphically. Fraser never claimed to have discovered the antagonism between physostigmine and atropine. Bartholow in 1873 did, based on work done in 1869. But his data hardly justify it. If anyone can reasonably claim this particular scientific crown it is an ophthalmologist, Niemetschek, working in Prague in 1864. His colleague in the same discipline, Kleinwächter, was faced with treating a young man with atropine intoxication. Knowing of the contrary actions of the two drugs on the pupil, Niemetschek suggested that Calabar bean extract might be useful. Kleinwächter had the courage to take the advice and his patient improved dramatically. Clearly, this evidence is nothing more than anecdotal, but the ophthalmologists were correct and, to the present day, physostigmine has had an intermittent role in the management of anticholinergic poisoning. The converse, giving atropine to treat poisoning with cholinesterase inhibitors, of which physostigmine was the first, has endured more consistently and remains standard practice today. It is salutary to realise that the doses and dosage frequency of atropine together with the endpoints that define they are adequate were formulated by Fraser and others a century and a half ago.


Assuntos
Inibidores da Colinesterase/história , Fisostigmina/história , Animais , Antídotos/uso terapêutico , Atropina/antagonistas & inibidores , Atropina/envenenamento , Atropina/uso terapêutico , Atropina/toxicidade , Inibidores da Colinesterase/envenenamento , Inibidores da Colinesterase/toxicidade , Antagonismo de Drogas , Fabaceae/química , História do Século XIX , História do Século XX , Humanos , Masculino , Antagonistas Muscarínicos/envenenamento , Antagonistas Muscarínicos/uso terapêutico , Antagonistas Muscarínicos/toxicidade , Fisostigmina/envenenamento , Fisostigmina/toxicidade
19.
Ther Drug Monit ; 28(3): 295-8, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16778709

RESUMO

An unexpectedly high number of initially suspected cocaine-intoxicated patients was presented to a general hospital in Lelystad, The Netherlands. Based on the unusual toxidram rate of not fitting cocaine intoxication, the suspicion of co-presence of an anticholinergic agent was raised. A newly developed HPLC-MS/MS analytical method revealed the presence of 10% atropine in a cocaine sample retrieved and subsequently in the sera of 6 intoxicated patients.


Assuntos
Atropina/sangue , Atropina/envenenamento , Antagonistas Colinérgicos/sangue , Antagonistas Colinérgicos/envenenamento , Transtornos Relacionados ao Uso de Cocaína/sangue , Adulto , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Países Baixos
20.
Clin Toxicol (Phila) ; 44(3): 301-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16749549

RESUMO

INTRODUCTION: The clinical effects of self injections of atropine-trimedoxime auto-injectors distributed to the civilian population as a field antidote for nerve agent attack were assessed. METHODS: Data on self injections by adults (> or = 18 years) were collected from the Israel Poison Information Center and a hospital Emergency Department's records during a 2-year period. The data included demographics, time interval from injection, type of auto-injector, clinical manifestations and atropinization score. RESULTS: Sixty-five patients, all with unintentional self injections, were reported. Systemic atropine effects were observed in 24 patients, but no severe atropinization. The atropinization score was significantly higher in the 2 mg atropine dose group than in the two lower dose groups, which were in the normal range. No specific adverse effects attributable to trimedoxime were observed. Intravenous fluids and physostigmine were not required. CONCLUSION: Only mild reactions were observed following self-injection of atropine trimedoxime auto-injectors in adults, attesting to their relative safety under these conditions.


Assuntos
Antídotos/envenenamento , Atropina/envenenamento , Automedicação/efeitos adversos , Trimedoxima/envenenamento , Acidentes/estatística & dados numéricos , Adulto , Antídotos/administração & dosagem , Atropina/administração & dosagem , Combinação de Medicamentos , Humanos , Injeções/instrumentação , Israel/epidemiologia , Envenenamento/epidemiologia , Envenenamento/fisiopatologia , Envenenamento/terapia , Trimedoxima/administração & dosagem
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