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2.
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
3.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 74-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31883205

RESUMO

OBJECTIVE: To describe the treatment and clinical course of a dog accidentally prescribed 10 times the recommended dose of colchicine (0.3 mg/kg/d instead of 0.03 mg/kg/d). CASE SUMMARY: After glaucoma surgery, a 1-year-old male neutered Pomeranian weighing 6.8 kg was prescribed 1,000 µg colchicine twice a day per os. The dog presented to the emergency department after the first dose with vomiting and was treated as an outpatient. Two colchicine doses later, the dog represented with vomiting, ocular pain, and increased intraocular pressure. The dog's vital signs were normal, and the dog was admitted for rehydration, analgesia, and revision glaucoma surgery the next day. Two hours after revision surgery, the dog developed vomiting and diarrhea. Postoperatively, the dog was hypothermic (36.3°C), persistently hypertensive (227 mm Hg), and bradycardic (60/min). Biochemistry revealed metabolic acidosis and increased hepatic enzyme activities. Mannitol was administered for presumed cerebral edema. Later, the dog developed bradycardia due to second-degree atrioventricular heart block, which responded to atropine. Total hospitalization was 9 days. Treatment included IV fluids, IV lipid emulsion, N-acetylcysteine, activated charcoal, gastroprotectants, antiemetics, opioids, antimicrobials, and barrier nursing due to transient neutropenia. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report to describe the successful treatment of a dog with colchicine overdose. The systemic effects were presumed to be secondary to colchicine toxicosis rather than diet, infection, or other drug reaction, and may have been compounded by a second anesthetic episode. Gastrointestinal signs, symptoms of cerebral edema, cardiac arrhythmias, and neutropenia were documented. One other report of colchicine overdose in a dog exists, and that patient was euthanized. This report demonstrates that complete recovery with intensive care is possible; however, the prognosis remains guarded.


Assuntos
Colchicina/envenenamento , Doenças do Cão/diagnóstico , Animais , Bradicardia/etiologia , Bradicardia/veterinária , Carvão Vegetal/uso terapêutico , Cuidados Críticos , Diarreia/etiologia , Diarreia/veterinária , Doenças do Cão/sangue , Doenças do Cão/terapia , Cães , Overdose de Drogas/complicações , Overdose de Drogas/veterinária , Hidratação/veterinária , Glaucoma/cirurgia , Glaucoma/veterinária , Masculino , Complicações Pós-Operatórias/veterinária , Vômito/etiologia , Vômito/veterinária
4.
Thromb Res ; 184: 86-91, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31710863

RESUMO

INTRODUCTION: Lupus Anticoagulant testing using dilute Russell Viper Venom Time (dRVVT) is challenging in patients receiving Direct Oral AntiCoagulants (DOAC) due to potential false positive results. In a multicenter study, we evaluated the in vitro removal of DOAC by activated charcoal (DOAC remove®), allowing reliable dRVVT testing. MATERIALS AND METHODS: Patient samples were analyzed before and after treatment with DOAC remove®: 49 apixaban, 48 rivaroxaban, 24 dabigatran and 30 none. DOAC plasma concentrations were measured using anti-Xa or diluted thrombin time assays. In a subset of 28 samples, DOAC concentrations were also measured using HPLC-MS/MS following treatment with DOAC remove®. DRVVT was performed using STA-Staclot dRVVT Screen®/Confirm® (Stago) or LAC-Screening®/Confirmation® (Siemens). RESULTS: Baseline median [min-max] concentrations were 94 [<20-479] for apixaban, 107 [<20-501] for rivaroxaban and 135 ng/mL [<20-792] for dabigatran; dRVVT screen ratio/confirm ratio was positive in 47, 90 and 42% of apixaban, rivaroxaban and dabigatran samples. Treatment with DOAC remove® did not affect dRVVT results in non-DOAC patients while it resulted in DOAC concentrations <20 ng/mL in 82, 98 and 100% of samples, respectively. Concentrations were <5 ng/mL with HPLC-MS/MS in 5 out of 10, 8 out of 10 and 7 out of 8 samples, respectively. DOAC remove® corrected DOAC interference with dRVVT assays in 76, 85 and 95% of the patients, respectively. CONCLUSION: For dRVVT testing in DOAC patients, we suggest the use of DOAC remove® for every rivaroxaban sample, whereas it might only be used in positive apixaban and dabigatran samples. A residual DOAC interference cannot be ruled out in case of persisting dRVVT positive results after treatment with DOAC remove®.


Assuntos
Anticoagulantes/uso terapêutico , Testes de Coagulação Sanguínea/métodos , Carvão Vegetal/uso terapêutico , Inibidor de Coagulação do Lúpus/sangue , Administração Oral , Anticoagulantes/farmacologia , Carvão Vegetal/farmacologia , Feminino , Humanos , Masculino
5.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 674-679, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31642158

RESUMO

OBJECTIVE: To describe the use of extracorporeal therapy (ECT) to treat severe cannabinoid intoxication in a dog with severe hyperlipidemia. CASE SUMMARY: A 7-month-old female intact Labrador Retriever presented with seizures and severe hyperesthesia that were refractory to multiple anticonvulsant medications and required induction of general anesthesia with propofol and mechanical ventilation. The dog's urine yielded a strong positive signal for delta-9-tetrahydrocannabinol (THC) on urine drug test and exposure to THC oil was confirmed by the owner. Bloodwork revealed severe hyperlipidemia such that IV lipid emulsion was considered contraindicated. The dog was treated with a 3-hour ECT session, using charcoal hemoperfusion and hemodialysis in series. Neurologic signs improved during the session and mechanical ventilation was discontinued. Immediately after the session, the dog's mentation was significantly improved and seizures and hyperesthesia had ceased, although the dog remained moderately ataxic. The dog was hospitalized for 36 hours following the ECT session for continued monitoring. The dog fully recovered and was successfully discharged. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first published report to document ECT to treat THC intoxication in veterinary medicine. ECT may be considered as a treatment option for severe THC intoxication that is refractory to standard therapy or where severe hyperlipidemia precludes use of IV lipid emulsions.


Assuntos
Canabinoides/toxicidade , Doenças do Cão/induzido quimicamente , Hemoperfusão/veterinária , Diálise Renal/veterinária , Respiração Artificial/veterinária , Convulsões/veterinária , Animais , Anticonvulsivantes/uso terapêutico , Carvão Vegetal/uso terapêutico , Doenças do Cão/terapia , Cães , Feminino , Propofol/uso terapêutico , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico
6.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 686-689, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637843

RESUMO

OBJECTIVE: To describe the clinical characteristics of acute chlorfenapyr toxicity in 3 dogs from a single household. CASE SUMMARY: A 4-year-old neutered female Labrador Retriever was presented with severe hyperthermia (42.6°C [108.6°F]). Emergency management consisting of fluid resuscitation, active cooling, general anesthesia, gastric lavage, activated charcoal administration, and intravenous lipid emulsion was started immediately on the suspicion of toxin exposure. The dog developed symptoms following peracute death in 2 other small breed dog housemates. All dogs had a rapid onset of gastrointestinal signs, neurologic signs, and panting. The dog made a rapid and complete recovery and was discharged 48 hours later. Examination of gastric contents collected from the deceased dogs identified the presence of chlorfenapyr. NEW OR UNIQUE INFORMATION PROVIDED: This is the first reported case of chlorfenapyr toxicity in dogs. Previous case reports in human medicine have reported a variable mortality rate, although 1 of 3 dogs described here made a complete recovery. Chlorfenapyr should be considered in cases of suspected toxicity with similar presenting signs.


Assuntos
Doenças do Cão/induzido quimicamente , Piretrinas/toxicidade , Animais , Carvão Vegetal/uso terapêutico , Cães , Emulsões Gordurosas Intravenosas/uso terapêutico , Evolução Fatal , Feminino , Febre/induzido quimicamente , Febre/terapia , Febre/veterinária , Envenenamento
7.
BMC Cancer ; 19(1): 859, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470821

RESUMO

BACKGROUND: We report on our experience of ultrasound (US)-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy (NAC) with clip and activated charcoal to guide axillary surgery in breast cancer patients. METHODS: Between November 2017 and May 2018, a dual-localization procedure was performed under US guidance for the most suspicious axillary nodes noted at initial staging (before NAC, with clip) and restaging (after NAC, with activated charcoal) in 28 cytologically proven node-positive breast cancer patients. Patients underwent axillary sampling or dissection, which involved removing not only the sentinel nodes (SNs), but also clipped nodes (CNs) and tattooed nodes (TNs). Success (or failure) rates of biopsies of SNs, CNs, and TNs and inter-nodal concordance rates were determined. Sensitivities for the individual and combined biopsies were calculated. RESULTS: SN biopsy failed in four patients (14%), whereas the CN biopsy failed in one patient (4%). All TNs were identified in the surgical field. Concordance rates were 79% for CNs-TNs, 63% for CNs-SNs, and 58% for TNs-SNs. Sensitivity for SN, CN, and TN biopsy was 73%, 67%, and 67%, respectively. Sensitivity was 80% for any combination of biopsies (SN plus CN, SN plus TN, SN plus CN plus TN). CONCLUSIONS: US-guided dual-localization of axillary nodes before and after NAC with clip and activated charcoal was a feasible approach that might facilitate more reliable nodal staging with less-invasive strategies in node-positive breast cancer patients.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Carvão Vegetal/administração & dosagem , Metástase Linfática/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Axila , Neoplasias da Mama/diagnóstico por imagem , Carvão Vegetal/uso terapêutico , Tratamento Farmacológico , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Sensibilidade e Especificidade , Ultrassonografia de Intervenção
8.
Am J Emerg Med ; 37(9): 1809.e1-1809.e3, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31257124

RESUMO

Half-life of the antipsychotic vegetamin is very long, partially due to the presence of phenobarbital, and mortality due to phenobarbital poisoning is high. Here, we present the case of a 22-year-old female admitted to the emergency department with disturbed consciousness due to vegetamin overdose. Her blood phenobarbital level was elevated to 123 µg/ml. Phenobarbital undergoes enterohepatic circulation, and its retention in the intestine causes its blood levels to remain sustained. The utility of hemodialysis for drug poisoning has been previously reported; however, its efficiency is not yet established and its efficacy is low for drugs with long half-lives such as phenobarbital. Therefore, we performed a two-tube approach to adsorb phenobarbital in the intestines with activated charcoal delivered via a gastric tube and to remove the phenobarbital-adsorbed activated charcoal using whole bowel irrigation via an ileus tube 2 h later. The patient successfully eliminated the charcoal via stool, the blood phenobarbital level decreased drastically without hemodialysis, and the clinical course improved. We propose that this two-tube approach is suitable for treatment of poisoning with drugs that undergo enterohepatic circulation and have long half-lives.


Assuntos
Carvão Vegetal/uso terapêutico , Overdose de Drogas/terapia , Hipnóticos e Sedativos/envenenamento , Fenobarbital/envenenamento , Circulação Êntero-Hepática/efeitos dos fármacos , Feminino , Hemoperfusão/métodos , Humanos , Hipnóticos e Sedativos/farmacocinética , Fenobarbital/farmacocinética , Adulto Jovem
9.
Tidsskr Nor Laegeforen ; 139(9)2019 May 28.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31140247

RESUMO

BACKGROUND: A woman in her fifties was admitted to hospital with decreased awareness and circulatory failure. She had been treated with left atrial cryoablation a few weeks before admission and had been cardioverted a few days after the procedure because of relapse of atrial fibrillation. CASE PRESENTATION: On admission, the patient had systolic blood pressure of 80 mm Hg and an ECG with broad QRS-complexes at 380 ms. We suspected intoxication and she was intubated to administer activated charcoal after gastric lavage. She was cardiovascularly unstable and in need of intravenous infusion of noradrenaline and adrenaline. Further investigations at her home suggested that she had poisoned herself with 4-5 g flecainide, 0.3 g oxazepam and 0.5 g meclizine. After administration of 500 mmol sodium bicarbonate and 5 mmol calcium chloride, the QRS complexes narrowed temporarily. On day 2, due to sustained bradycardia and hypotension despite receiving adrenergic medications, a temporary pacemaker was implanted, leading to improved heart rate and blood pressure. She experienced several complications including hypertensive pulmonary oedema, atrial fibrillation, extensively prolonged QT interval because of polypharmacy and Takotsubo cardiomyopathy. She was discharged from the hospital in good health on day 17. At a follow-up visit at the outpatient clinic 12 weeks later, cardiac function had normalised. The QT interval was now normal; however, there were persistent T-wave inversions in leads I, aVL and V4-6. INTERPRETATION: Flecainide blocks sodium channels in cardiomyocytes. Intoxication with flecainide is rare, with mortality rates of about 10 %. Sodium bicarbonate in larger doses has been reported to stabilise patients with flecainide intoxication due to modification of the binding of flecainide to sodium receptors in cardiomyocytes, and due to alkalisation which makes flecainide detach from sodium receptors. Our patient had a temporary effect with narrowing of QRS complexes after receiving sodium bicarbonate. She also showed a beneficial effect from implantation of a temporary pacemaker, although earlier case reports have described problems with high thresholds and capture failure.


Assuntos
Antiarrítmicos/envenenamento , Overdose de Drogas , Flecainida/envenenamento , Carvão Vegetal/uso terapêutico , Overdose de Drogas/complicações , Overdose de Drogas/terapia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Marca-Passo Artificial , Choque/induzido quimicamente , Choque/terapia , Sonolência , Bicarbonato de Sódio/uso terapêutico
11.
Vet Clin Pathol ; 48(1): 67-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30924544

RESUMO

A 4-year-old, spayed female French Bulldog was presented for respiratory distress and suspected aspiration pneumonia after oral administration of activated charcoal for possible ingestion of a suspected toxic dose of trazodone. The patient had a moderate volume of pleural effusion, which contained free and intracellular black particulate matter consistent with charcoal. Due to presumed charcoal aspiration with subsequent lung rupture, the right middle and right caudal lung lobes were surgically removed. Histology revealed abundant black debris consistent with charcoal and severe granulomatous inflammation. Based on the clinical, gross, and histologic findings, a diagnosis of severe, chronic, locally extensive, aspiration pneumonia and lung rupture with secondary pleuritis and mediastinitis due to charcoal aspiration was made. Aspiration pneumonia is the main complication of activated charcoal administration, which can incite extensive, granulomatous inflammation in the respiratory tract. To the authors' knowledge, this is the first report describing the cytologic and histologic findings associated with inadvertent charcoal aspiration in a veterinary species.


Assuntos
Carvão Vegetal/efeitos adversos , Doenças do Cão/patologia , Lesão Pulmonar/veterinária , Pneumonia Aspirativa/veterinária , Animais , Carvão Vegetal/uso terapêutico , Doenças do Cão/cirurgia , Cães , Feminino , Granuloma/patologia , Granuloma/veterinária , Pulmão/patologia , Pulmão/cirurgia , Lesão Pulmonar/cirurgia , Derrame Pleural/patologia , Derrame Pleural/veterinária , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/patologia , Trazodona/envenenamento
12.
Biol Pharm Bull ; 42(3): 432-441, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30828075

RESUMO

Moutan Cortex charcoal has been used to ameliorate blood heat symptoms and treat pathologic hemorrhage down the ages. Although well known as an agent with the effect of astringency and hemostasis, its active ingredients and action mechanism remain unclear. In the present study, molecular docking technology was employed to screen the potential hemostatic compounds in Moutan Cortex charcoal and their target proteins. Protein-protein-interaction (PPI) analysis was performed to explain the functions and enrichment pathways of the target proteins. The results showed that a total of 25 compounds were estimated as active constituents targeting multiple proteins related to hemostatic diseases, including 5 proteins (SERPINC1, FVIII, FX, FII and FXII) that were considered as the key targets. Then the drug-target (D-T) network was constructed to analyze the underlying hemostatic mechanism of Moutan Cortex charcoal, followed by a hierarchical cluster analysis (HCA) for compounds clustering, and a coagulation screening test for compound verification on their coagulation activities, with the results indicating that M15 (5-Tetradecenoic acid) and M31 (1-Monolinolein) might be the key compounds contributing to the hemostasis effect of Moutan Cortex charcoal by involving in the pathways related to complement, coagulation cascades and the platelet activation, particularly by activating FVIII, FX, FII and FXII and inhibiting SERPINC1. This study has demonstrated that Moutan Cortex charcoal may work as a hemostatic through the interaction between multiple-compounds and multiple-proteins, which provides the basis for further researches on the hemostasis mechanism of Moutan Cortex charcoal.


Assuntos
Carvão Vegetal/química , Carvão Vegetal/uso terapêutico , Medicamentos de Ervas Chinesas/química , Transtornos Hemorrágicos/tratamento farmacológico , Paeonia/química , Humanos , Simulação de Acoplamento Molecular , Estrutura Molecular , Ligação Proteica , Proteínas/química
13.
J Med Case Rep ; 13(1): 45, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30808405

RESUMO

INTRODUCTION: Gastric pharmacobezoars are a rare entity that can induce mechanical gastric outlet obstructions and sometimes prolong toxic pharmacological effects. Certain medications, such as sustained-release forms, contain cellulose derivatives that may contribute to the adhesion between pills and lead to the creation of an aggregate resulting in a pharmacobezoar. Case reports are rare, and official guidelines are needed to help medical teams choose proper treatment options. CASE PRESENTATION: Our patient was a 40-year-old Caucasian woman with borderline personality disorder and active suicidal thoughts who was found unconscious after a massive drug consumption of slow-release clomipramine, lorazepam, and domperidone. On her arrival in the emergency room, endotracheal intubation was preformed to protect her airway, and a chest x-ray revealed multiple coffee grain-sized opaque masses in the stomach. She was treated with activated charcoal followed by two endoscopic gastric decontaminations 12 h apart in order to extract a massive gastric pharmacobezoar by manual removal of the tablets. CONCLUSION: This case demonstrates that in the case of a massive drug consumption, a pharmacobezoar should be suspected, particularly when cellulose-coated pills are ingested. Severe poisoning due to delayed drug release from the gastric aggregate is a potential complication. Detection by x-ray is crucial, and treatment is centered on removal of the aggregate. The technique of decontamination varies among experts, and no formal recommendations exist to date. It seems reasonable that endoscopic evaluation should be performed in order to determine the appropriate technique of decontamination. Care should be patient-oriented and take into account the clinical presentation and any organ failure, and it should not be determined solely by the suspected medication ingested. Thus, serum levels are not sufficient to guide management of tricyclic antidepressant intoxication.


Assuntos
Antidepressivos Tricíclicos/envenenamento , Bezoares/induzido quimicamente , Clomipramina/envenenamento , Preparações de Ação Retardada/envenenamento , Domperidona/envenenamento , Overdose de Drogas/patologia , Lorazepam/envenenamento , Adulto , Antidepressivos Tricíclicos/farmacocinética , Bezoares/patologia , Carvão Vegetal/uso terapêutico , Clomipramina/farmacocinética , Preparações de Ação Retardada/farmacocinética , Domperidona/farmacocinética , Overdose de Drogas/complicações , Endoscopia , Feminino , Humanos , Lorazepam/farmacocinética , Tentativa de Suicídio , Resultado do Tratamento
14.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739090

RESUMO

We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly. On second day of admission he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of acute respiratory distress syndrome (ARDS). The patient had to be intubated. Continuous renal replacement therapy (CRRT) was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient succumbed to illness. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on ABG and was corrected accordingly. On second day of admission, he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of ARDS. The patient had to be intubated on day 2. CRRT was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient gradually deteriorated, had cardiac arrest and passed away on day 5 of his hospital stay.


Assuntos
Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Lavagem Gástrica/métodos , Malpighiales , Extratos Vegetais/envenenamento , Envenenamento/terapia , Suicídio , Acidose/induzido quimicamente , Acidose/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/etiologia , Terapia de Substituição Renal , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente , Síndrome do Desconforto Respiratório do Adulto/terapia
16.
Forensic Sci Rev ; 31(1): 23-36, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30594904

RESUMO

The aim of this paper is to highlight the symptomatology in three Conium maculatum intoxication incidents, one of which was fatal. A number of studies were reviewed in order to update and summarize the relevant literature on the incidence, sociodemographic variables, method of poisoning, pathophysiology, diagnosis, variables associated with survival and fatality, management, and treatment of C. maculatum intoxication as well as the biosynthesis and biological effects of poison hemlock alkaloids. Results show that hemlock poisoning is relatively rare, although incidence varies in different regions, despite its worldwide distribution. Hemlock poisoning is more common in European and especially Mediterranean countries. The majority of the patients are adult males over 38 years of age. The clinical course of hemlock poisoning includes neurotoxicosis, tremor, vomiting, muscle paralysis, respiratory paralysis/failure, rhabdomyolysis, and acute renal failure. The therapeutic management focuses on absorption reduction, close observation for complications, and supportive therapy (especially for respiration). Acute occurrence is severe and life-threatening, but the survival rate is high if treatment is provided promptly. Recovery is rapid, generally taking only a few days.


Assuntos
Conium/envenenamento , Intoxicação por Plantas/diagnóstico , Intoxicação por Plantas/epidemiologia , Acidentes/mortalidade , Idoso , Alcaloides/análise , Alcaloides/biossíntese , Alcaloides/química , Animais , Antídotos/uso terapêutico , Antieméticos/uso terapêutico , Carvão Vegetal/uso terapêutico , Cromatografia Líquida , Conium/anatomia & histologia , Conium/fisiologia , Cromatografia Gasosa-Espectrometria de Massas , Lavagem Gástrica , Humanos , Gado , Masculino , Estrutura Molecular , Fitoterapia , Piperidinas/análise , Paralisia Respiratória/induzido quimicamente , Paralisia Respiratória/terapia , Rabdomiólise/induzido quimicamente , Rabdomiólise/terapia , Suicídio
17.
Cochrane Database Syst Rev ; 12: CD013230, 2018 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-30565220

RESUMO

BACKGROUND: Oral poisoning is a major cause of mortality and disability worldwide, with estimates of over 100,000 deaths due to unintentional poisoning each year and an overrepresentation of children below five years of age. Any effective intervention that laypeople can apply to limit or delay uptake or to evacuate, dilute or neutralize the poison before professional help arrives may limit toxicity and save lives. OBJECTIVES: To assess the effects of pre-hospital interventions (alone or in combination) for treating acute oral poisoning, available to and feasible for laypeople before the arrival of professional help. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, ISI Web of Science, International Pharmaceutical Abstracts, and three clinical trials registries to 11 May 2017, and we also carried out reference checking and citation searching. SELECTION CRITERIA: We included randomized controlled trials comparing interventions (alone or in combination) that are feasible in a pre-hospital setting for treating acute oral poisoning patients, including but potentially not limited to activated charcoal (AC), emetics, cathartics, diluents, neutralizing agents and body positioning. DATA COLLECTION AND ANALYSIS: Two reviewers independently performed study selection, data collection and assessment. Primary outcomes of this review were incidence of mortality and adverse events, plus incidence and severity of symptoms of poisoning. Secondary outcomes were duration of symptoms of poisoning, drug absorption, and incidence of hospitalization and ICU admission. MAIN RESULTS: We included 24 trials involving 7099 participants. Using the Cochrane 'Risk of bias' tool, we assessed no study as being at low risk of bias for all domains. Many studies were poorly reported, so the risk of selection and detection biases were often unclear. Most studies reported important outcomes incompletely, and we judged them to be at high risk of reporting bias.All but one study enrolled oral poisoning patients in an emergency department; the remaining study was conducted in a pre-hospital setting. Fourteen studies included multiple toxic syndromes or did not specify, while the other studies specifically investigated paracetamol (2 studies), carbamazepine (2 studies), tricyclic antidepressant (2 studies), yellow oleander (2 studies), benzodiazepine (1 study), or toxic berry intoxication (1 study). Eighteen trials investigated the effects of activated charcoal (AC), administered as a single dose (SDAC) or in multiple doses (MDAC), alone or in combination with other first aid interventions (a cathartic) and/or hospital treatments. Six studies investigated syrup of ipecac plus other first aid interventions (SDAC + cathartic) versus ipecac alone. The collected evidence was mostly of low to very low certainty, often downgraded for indirectness, risk of bias or imprecision due to low numbers of events.First aid interventions that limit or delay the absorption of the poison in the bodyWe are uncertain about the effect of SDAC compared to no intervention on the incidence of adverse events in general (zero events in both treatment groups; 1 study, 451 participants) or vomiting specifically (Peto odds ratio (OR) 4.17, 95% confidence interval (CI) 0.30 to 57.26, 1 study, 25 participants), ICU admission (Peto OR 7.77, 95% CI 0.15 to 391.93, 1 study, 451 participants) and clinical deterioration (zero events in both treatment groups; 1 study, 451 participants) in participants with mixed types or paracetamol poisoning, as all evidence for these outcomes was of very low certainty. No studies assessed SDAC for mortality, duration of symptoms, drug absorption or hospitalization.Only one study compared SDAC to syrup of ipecac in participants with mixed types of poisoning, providing very low-certainty evidence. Therefore we are uncertain about the effects on Glasgow Coma Scale scores (mean difference (MD) -0.15, 95% CI -0.43 to 0.13, 1 study, 34 participants) or incidence of adverse events (risk ratio (RR) 1.24, 95% CI 0.26 to 5.83, 1 study, 34 participants). No information was available concerning mortality, duration of symptoms, drug absorption, hospitalization or ICU admission.This review also considered the added value of SDAC or MDAC to hospital interventions, which mostly included gastric lavage. No included studies investigated the use of body positioning in oral poisoning patients.First aid interventions that evacuate the poison from the gastrointestinal tractWe found one study comparing ipecac versus no intervention in toxic berry ingestion in a pre-hospital setting. Low-certainty evidence suggests there may be an increase in the incidence of adverse events, but the study did not report incidence of mortality, incidence or duration of symptoms of poisoning, drug absorption, hospitalization or ICU admission (103 participants).In addition, we also considered the added value of syrup of ipecac to SDAC plus a cathartic and the added value of a cathartic to SDAC.No studies used cathartics as an individual intervention.First aid interventions that neutralize or dilute the poison No included studies investigated the neutralization or dilution of the poison in oral poisoning patients.The review also considered combinations of different first aid interventions. AUTHORS' CONCLUSIONS: The studies included in this review provided mostly low- or very low-certainty evidence about the use of first aid interventions for acute oral poisoning. A key limitation was the fact that only one included study actually took place in a pre-hospital setting, which undermines our confidence in the applicability of these results to this setting. Thus, the amount of evidence collected was insufficient to draw any conclusions.


Assuntos
Primeiros Socorros/métodos , Envenenamento/terapia , Acetaminofen/envenenamento , Analgésicos não Entorpecentes/envenenamento , Antidepressivos/envenenamento , Antídotos/uso terapêutico , Benzodiazepinas/envenenamento , Carbamazepina/envenenamento , Catárticos/uso terapêutico , Carvão Vegetal/uso terapêutico , Frutas/envenenamento , Humanos , Ipeca/uso terapêutico , Envenenamento/etiologia , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Thevetia/envenenamento
18.
Medicine (Baltimore) ; 97(30): e11669, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30045322

RESUMO

RATIONALE: Paraquat, an agent highly toxic to humans and animals, is a widely used herbicide and also commonly used for suicide attempts in Taiwan. The most common route of intoxication is oral ingestion, and parenteral poisoning is respectively rare. PATIENT CONCERNS: A 39-year-old illicit abuser of heroin and amphetamine injected 0.5 mL of 24% paraquat directly into his right cephalic vein due to hallucination. The patient was brought to our emergency department for management 4 hours after injection. He was fully conscious and had normal vital signs. Systemic review showed mild dyspnea, abdominal pain and right wrist pain over the injection site. The only abnormal physical finding was erythema over the injection site and epigastric tenderness. DIAGNOSIS: Laboratory investigations, including complete blood count, liver and renal function, and electrolytes initially yielded normal results. Urinalysis showed normal findings except a positive urine paraquat test (4+). The initial plasma paraquat concentration was 0.51 µg/mL. INTERVENTIONS: He was admitted to the intensive care unit and underwent one session of charcoal hemoperfusion therapy. Acute kidney injury developed on the fourth day after intoxication, with the level of serum creatinine rising rapidly from 0.96 to 4.57 mg/dL and the daily urine output decreased noticeably from > 2000 to 900 mL. The serum creatinine level improved gradually with adequate fluid supplementation. OUTCOMES: The patient was discharged 13 days later in a stable condition. LESSONS: Intravenous paraquat intoxication is rare. Patients who suffer from intravenous intoxication may not directly suffer from mucosal irritation, but the clinical onset of systemic effects is more immediate and lethal. The prognosis of paraquat poisoning is determined by the time of poisoning and the plasma paraquat concentration before treatment. Proudfoot's curve provides a simple method of predicting the survival rate. The most effective mode of management is extracorporeal therapy, and immunosuppressive or antioxidant therapies have shown insufficient evidence of benefit.


Assuntos
Paraquat/envenenamento , Lesão Renal Aguda/induzido quimicamente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/complicações , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Alucinações/complicações , Hemoperfusão , Dependência de Heroína/complicações , Humanos , Injeções Intravenosas , Masculino , Paraquat/administração & dosagem , Paraquat/sangue , Envenenamento/terapia , Resultado do Tratamento
19.
J R Army Med Corps ; 164(6): 450-457, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29934414

RESUMO

Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.


Assuntos
Drogas Ilícitas/efeitos adversos , Militares , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Antídotos/uso terapêutico , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Canabinoides/administração & dosagem , Canabinoides/efeitos adversos , Cardiotoxicidade/etiologia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Carvão Vegetal/uso terapêutico , Emulsões/uso terapêutico , Alucinógenos/administração & dosagem , Alucinógenos/efeitos adversos , Humanos , Fosfolipídeos/uso terapêutico , Psicotrópicos/administração & dosagem , Óleo de Soja/uso terapêutico , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Reino Unido
20.
Clin Toxicol (Phila) ; 56(12): 1173-1178, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29893609

RESUMO

OBJECTIVES: Racial and ethnic disparities in the United States continue to exist in many disciplines of medicine, extending to care in the Emergency Department (ED). We sought to examine the relationship between patient race/ethnicity and use of either antidotal therapy or gastrointestinal decontamination for individuals presenting to the ED for acute drug overdose. METHODS: We completed a secondary analysis of a prospective cohort of patients with suspected acute overdose presenting to two urban tertiary care hospitals between 2009 and 2014. Race was self-identified during ED registration. Antidote administration (primary outcome) and gastrointestinal decontamination (secondary outcome) were reviewed and verified via agreement between two board certified medical toxicologists. Associations between race and outcomes were analyzed using a logistic regression model. RESULTS: We reviewed 3252 ED patients with acute overdose. Overall, 542 people were treated with an antidote and 234 cases were treated with activated charcoal, either single or multiple dose. Compared to Whites, Blacks and Hispanics were significantly less likely to receive any antidote. The analysis was underpowered to detect racial disparities in the administration of activated charcoal. CONCLUSIONS: Blacks and Hispanics are significantly less likely to receive any antidote when presenting to the ED for acute drug overdose. Further studies are needed to determine national prevalence of this apparent disparity in care and to fully characterize how race plays a role in management of acute overdose.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Criança , Estudos de Coortes , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Trato Gastrointestinal/microbiologia , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
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