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1.
MMWR Morb Mortal Wkly Rep ; 69(34): 1149-1155, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32853194

RESUMO

The U.S. drug overdose epidemic continues to cause substantial morbidity and mortality. In 2017, 967,615 nonfatal drug overdoses were treated in emergency departments (EDs), a 4.3% increase from 2016 in all overdoses and a 3.1% increase in opioid-involved overdoses (1). During 2017 and 2018, syndromic surveillance revealed that 37.2% of overdoses treated in EDs in 18 states involved multiple drugs (2). To describe changes in rates and proportions of suspected nonfatal drug and polydrug overdoses treated in EDs, CDC analyzed syndromic surveillance data from 2018 to 2019 in 29 states. Rates of overdoses involving opioids, cocaine, and amphetamines increased 9.7%, 11.0%, and 18.3%, respectively, and the rate of benzodiazepine-involved overdoses decreased 3.0%. Overdoses co-involving opioids and amphetamines increased from 2018 to 2019, overall, in both sexes, and in most age groups. In 2019, 23.6%, 17.1%, and 18.7% of overdoses involving cocaine, amphetamine, and benzodiazepines, respectively, also involved opioids. Expanding overdose prevention, treatment, and response efforts is needed to reduce the number of drug and polydrug overdoses. This includes linkage into treatment, harm reduction services, and community-based programs for persons who use drugs; expanding overdose prevention efforts, including increased naloxone provision, to persons who use stimulants; addressing the illicit drug supply; and identifying specific risk factors for populations using these drugs. Continued surveillance with expanded coverage of additional jurisdictions of the evolving drug overdose epidemic is important to the success of these efforts.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Polimedicação , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
N Engl J Med ; 382(22): 2129-2136, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32459923

RESUMO

BACKGROUND: The opioid crisis highlights the need to increase access to naloxone, possibly through regulatory approval for over-the-counter sales. To address industry-perceived barriers to such access, the Food and Drug Administration (FDA) developed a model drug facts label for such sales to assess whether consumers understood the key statements for safe and effective use. METHODS: In this label-comprehension study, we conducted individual structured interviews with 710 adults and adolescents, including 430 adults who use opioids and their family and friends. Eight primary end points were developed to assess user comprehension of each of the key steps in the label. Each of these end points included a prespecified target threshold ranging from 80 to 90% that was evaluated through a comparison of the lower boundary of the 95% exact confidence interval. RESULTS: The results for performance on six primary end points met or exceeded thresholds, including the steps "Check for a suspected overdose" (threshold, 85%; point estimate [PE], 95.8%; 95% confidence interval [CI], 94.0 to 97.1) and "Give the first dose" (threshold, 85%; PE, 98.2%; 95% CI, 96.9 to 99.0). The lower boundaries for four other primary end points ranged from 88.8 to 94.0%. One exception was comprehension of "Call 911 immediately," but this instruction closely approximated the target of 90% (PE, 90.3%; 95% CI, 87.9 to 92.4). Another exception was comprehension of the composite step of "Check, give, and call 911 immediately" (threshold, 85%; PE, 81.1%; 95% CI, 78.0 to 83.9). CONCLUSIONS: Consumers met thresholds for sufficient understanding of six of eight components of the instructions in the drug facts label for naloxone use and came close on two others. Overall, the FDA found that the model label was adequate for use in the development of a naloxone product intended for over-the-counter sales.


Assuntos
Analgésicos Opioides/envenenamento , Compreensão , Rotulagem de Medicamentos , Overdose de Drogas/tratamento farmacológico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Adolescente , Adulto , Rotulagem de Medicamentos/legislação & jurisprudência , Overdose de Drogas/terapia , Regulamentação Governamental , Humanos , Entrevistas como Assunto , Estados Unidos , United States Food and Drug Administration
4.
JAMA Netw Open ; 3(5): e205852, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32459355

RESUMO

Importance: Timely initiation and referral to treatment for patients with opioid use disorder seen in the emergency department is associated with reduced mortality. It is not known how often commercially insured adults obtain follow-up treatment after nonfatal opioid overdose. Objective: To investigate the incidence of follow-up treatment following emergency department discharge after nonfatal opioid overdose and patient characteristics associated with receipt of follow-up treatment. Design, Setting, and Participants: A retrospective cohort study was conducted using an administrative claims database for a large US commercial insurer, from October 1, 2011, to September 30, 2016. Data analysis was performed from May 1, 2019, to September 26, 2019. Adult patients discharged from the emergency department after an index opioid overdose (no overdose in the preceding 90 days) were included. Patients with cancer and without continuous insurance enrollment were excluded. Main Outcomes and Measures: The primary outcome was follow-up treatment in the 90 days following overdose, defined as a combined outcome of claims for treatment encounters or medications for opioid use disorder (buprenorphine and naltrexone). Analysis was stratified by whether patients received treatment for opioid use disorder in the 90 days before the overdose. Logistic regression models were used to identify patient characteristics associated with receipt of follow-up treatment. Marginal effects were used to report the average adjusted probability and absolute risk differences (ARDs) in follow-up for different patient characteristics. Results: A total of 6451 patients were identified with nonfatal opioid overdose; the mean (SD) age was 45.0 (19.3) years, 3267 were women (50.6%), and 4676 patients (72.5%) reported their race as non-Hispanic white. A total of 1069 patients (16.6%; 95% CI, 15.7%-17.5%) obtained follow-up treatment within 90 days after the overdose. In adjusted analysis of patients who did not receive treatment before the overdose, black patients were half as likely to obtain follow-up compared with non-Hispanic white patients (ARD, -5.9%; 95% CI, -8.6% to -3.6%). Women (ARD, -1.7%; 95% CI, -3.3% to -0.5%) and Hispanic patients (ARD, -3.5%; 95% CI, -6.1% to -0.9%) were also less likely to obtain follow-up. For each additional year of age, patients were 0.2% less likely to obtain follow-up (95% CI, -0.3% to -0.1%). Conclusions and Relevance: Efforts to improve the low rate of timely follow-up treatment following opioid overdose may seek to address sex, race/ethnicity, and age disparities.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Seguro Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/terapia , Adulto , Overdose de Drogas/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
5.
MMWR Morb Mortal Wkly Rep ; 69(13): 371-376, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32240125

RESUMO

In 2017, drug overdoses caused 70,237 deaths in the United States, a 9.6% rate increase from 2016 (1). Monitoring nonfatal drug overdoses treated in emergency departments (EDs) is also important to inform community prevention and response activities. Analysis of discharge data provides insights into the prevalence and trends of nonfatal drug overdoses, highlighting opportunities for public health action to prevent overdoses. Using discharge data from the Healthcare Cost and Utilization Project's (HCUP) Nationwide Emergency Department Sample (NEDS), CDC identified nonfatal overdoses for all drugs, all opioids, nonheroin opioids, heroin, benzodiazepines, and cocaine and examined changes from 2016 to 2017, stratified by drug type and by patient, facility, and visit characteristics. In 2017, the most recent year for which population-level estimates of nonfatal overdoses can be generated, a total of 967,615 nonfatal drug overdoses were treated in EDs, an increase of 4.3% from 2016, which included 305,623 opioid-involved overdoses, a 3.1% increase from 2016. From 2016 to 2017, the nonfatal overdose rates for all drug types increased significantly except for those involving benzodiazepines. These findings highlight the importance of continued surveillance of nonfatal drug overdoses treated in EDs to inform public health actions and, working collaboratively with clinical and public safety partners, to link patients to needed recovery and treatment resources (e.g., medication-assisted treatment).


Assuntos
Overdose de Drogas/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Overdose de Drogas/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
6.
S D Med ; 73(3): 106-110, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32142228

RESUMO

Baclofen (Lioresal) is a derivative of gamma-aminobutyric acid and is used in both adults and children mainly for symptomatic treatment of muscle spasticity. It is absorbed completely from the gastrointestinal tract, metabolized minimally in the liver and is excreted almost unchanged by the kidneys. Being lipophilic it can cross the blood-brain barrier easily. Baclofen overdose can result in life threatening complications such as respiratory failure, metabolic encephalopathy, seizures, deep coma and autonomic instability leading to hypertension and bradycardia.1-5 The literature on oral baclofen overdose in young children is very sparse. Here we report a 2-year-old-girl who was found by her parents after an accidental ingestion of her father's baclofen. The child presented with respiratory failure, coma, hypotonia and bradycardia. The patient was managed conservatively; mechanically ventilated for 16 hours and was discharged home after 48 hours with no sequelae.


Assuntos
Baclofeno , Coma , Relaxantes Musculares Centrais , Insuficiência Respiratória , Adulto , Baclofeno/envenenamento , Pré-Escolar , Coma/induzido quimicamente , Overdose de Drogas/terapia , Feminino , Humanos , Relaxantes Musculares Centrais/envenenamento , Insuficiência Respiratória/induzido quimicamente
9.
Aust J Gen Pract ; 49(1-2): 73-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32008260

RESUMO

BACKGROUND: Gamma hydroxybutyrate (GHB) is an illicit drug commonly used in music festival, party and 'chemsex' settings. Most people who use GHB do so occasionally, without dependent use or withdrawal symptoms. However, a minority of users experience harms including unconsciousness and respiratory collapse in overdose. Adverse interactions can also occur when GHB is used with other drugs (eg methamphetamine), necessitating assessment, management or onward referral by general practitioners. OBJECTIVE: This article describes the use of GHB, with a contemporary update on principles of assessment and management in general practice, brief intervention and harm-minimisation strategies, and indicators for referral to a specialist in dependent use. DISCUSSION: The assessment and management of individuals with GHB-related harms in general practice is supported by an awareness of the context of use, familiarity with targeted harm-minimisation advice and cognisance of markers of risk indicating onward referral to specialist addiction services when appropriate.


Assuntos
Oxibato de Sódio/análise , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adjuvantes Anestésicos/efeitos adversos , Adjuvantes Anestésicos/análise , Overdose de Drogas/diagnóstico , Overdose de Drogas/terapia , Medicina Geral/métodos , Medicina Geral/tendências , Humanos , Oxibato de Sódio/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/psicologia
10.
Ann Emerg Med ; 75(5): 568-575, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31983498

RESUMO

STUDY OBJECTIVE: We describe the prevalence, trends, and factors associated with repeated emergency department (ED) encounters for opioid usage across multiple, independent hospital systems. METHODS: A statewide regional health information exchange system provided ED encounters from 4 Indiana hospital systems for 2012 to 2017. In accordance with a series of International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 diagnosis codes for opioid abuse, adverse effects of opioids, opioid dependence and unspecified use, and opioid poisoning, we identified patients with an ED encounter associated with opioid usage (9,295 individuals; 12,642 encounters). Multivariate logistic regression models then described the patient, encounter, prescription history, and community characteristics associated with the odds of a patient's incurring a subsequent opioid-related ED encounter. RESULTS: The prevalence of repeated nonfirst opioid-related ED encounters increased from 9.0% of all opioid encounters in 2012 to 34.3% in 2017. The number of previous opioid-related ED encounters, unique institutions at which the individual had had encounters, the encounter's being heroin-related, the individual's having a benzodiazepine prescription filled within 30 days before the encounter, and being either Medicaid insured or uninsured compared with private insurance were associated with significantly greater odds of having a subsequent encounter. CONCLUSION: The ED is increasingly a site utilized as the setting for repeated opioid-related care. Characteristics of the individual, encounter, and community associated with repeated opioid-related encounters may inform real-time risk-prediction tools in the ED setting. Additionally, the number of institutions to which the individual has presented may suggest the utility of health information exchange data and usage in the ED setting.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Overdose de Drogas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
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
15.
PLoS Med ; 16(11): e1002963, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31743335

RESUMO

BACKGROUND: In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD. METHODS AND FINDINGS: Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources. CONCLUSIONS: Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.


Assuntos
Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Analgésicos Opioides/uso terapêutico , Protocolos Clínicos , Estudos Transversais , Overdose de Drogas/psicologia , Overdose de Drogas/terapia , Humanos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos , Rhode Island/epidemiologia , Medição de Risco/métodos , Fatores de Risco , Serviço Social , Participação dos Interessados , Estados Unidos/epidemiologia
16.
Pediatr Clin North Am ; 66(6): 1099-1108, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31679600

RESUMO

Although recent spikes in overdose deaths are largely attributable to heroin and fentanyl, prescription opioids still account for a significant percentage of overdose deaths. Additionally, overdose deaths are not a problem solely for adults; roughly 8% of all overdose deaths occur in persons aged 15 to 24. In addition to identifying factors that increase risk for misuse and negative outcomes among adolescents, research must examine the causal mechanisms that link these factors to increased risk. Finally, the extant research must serve as the foundation for prevention/intervention strategies and identify treatments that are effective among adolescents with opioid use disorders.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Uso Indevido de Medicamentos sob Prescrição , Adolescente , Comportamento do Adolescente/psicologia , Saúde do Adolescente , Overdose de Drogas/epidemiologia , Overdose de Drogas/etiologia , Overdose de Drogas/psicologia , Overdose de Drogas/terapia , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/terapia , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Uso Indevido de Medicamentos sob Prescrição/psicologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Fatores de Risco , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia
17.
Arch Pediatr ; 26(8): 475-478, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685412

RESUMO

The number of reports on baclofen intoxication has increased in recent years. Here we report the case of a 4-year-old boy in deep coma who was referred to the pediatric intensive care unit. The patient was intubated and mechanically ventilated. A computerized tomography scan without contrast showed a collapsed appearance of the ventricular system suggesting diffuse cerebral edema. A multichannel electroencephalogram registered 6 h after admission showed a very slow and ample continuous pattern, without structure, nonreactive to stimulations, expressing diffuse and severe nonspecific cerebral pain. A targeted analysis to determine the baclofen plasma levels was performed. Test results of plasma samples were highly positive for baclofen (2009 ng/mL). Following 36 h of mechanical ventilation, the patient rapidly regained consciousness and recovered normal neurological behavior. The present case demonstrates the importance of considering baclofen overdosage in cases of deep coma with areflexia, and emphasizes the importance of warning parents about the potential toxicity of baclofen when prescribing the drug to a family member. A review of the literature on pediatric baclofen overdose is included.


Assuntos
Baclofeno/envenenamento , Coma/induzido quimicamente , Overdose de Drogas/complicações , Pré-Escolar , Coma/terapia , Overdose de Drogas/terapia , Humanos , Masculino , Índice de Gravidade de Doença
18.
S Afr Med J ; 109(9): 635-638, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635586

RESUMO

Calcium channel blockers (CCBs) are commonly used in South Africa (SA) in the management of hypertension and other cardiovascular disease. Their ubiquitous availability makes them a common agent in drug overdose (OD), whether through accidental ingestion or deliberate self-harm. It is essential that medical practitioners know how to recognise and manage CCB OD, as severe CCB OD is often fatal. As there is a lack of local literature in SA, we highlight the general principles of management of CCB OD, as well as complications and problems that may be encountered during treatment. This narrative review is based on existing clinical guidelines, retrospective studies and systematic reviews on the emergency management of CCB OD. High-dose insulin euglycaemic therapy has become the mainstay of treatment in severe CCB OD. The rationale, the recommended protocol for its use and its adverse effects are described.


Assuntos
Bloqueadores dos Canais de Cálcio/envenenamento , Overdose de Drogas/terapia , Tratamento de Emergência/métodos , Bloqueadores dos Canais de Cálcio/administração & dosagem , Doenças Cardiovasculares/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Insulina/administração & dosagem , Guias de Prática Clínica como Assunto , África do Sul
19.
Vnitr Lek ; 65(6): 425-432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484483

RESUMO

The second part of the review deals in detail with the diagnostics and treatment of toxic alcohols poisoning and management and indication of extracorporeal removal techniques in intoxication with other drugs, theophylline, valproic acid, metformin and metformin associated lactic acidosis, respectively. The extracorporeal treatment enhances the clearance of the toxin and corrects patients metabolic disturbances as well. It is necessary to use this treatment in severe intoxications. Indication of this invasive procedure falls within clinicians and nephrologists competence being advised by a toxicologist. This review could help make fast decisions.


Assuntos
Acidose Láctica , Overdose de Drogas , Hipoglicemiantes , Metformina , Overdose de Drogas/terapia , Humanos , Hipoglicemiantes/farmacocinética , Metformina/farmacocinética , Diálise Renal , Teofilina
20.
Am J Emerg Med ; 37(12): 2264.e5-2264.e8, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31477360

RESUMO

BACKGROUND: We report a patient with a massive hydroxychloroquine overdose manifested by profound hypokalemia and ventricular dysrhythmias and describe hydroxychloroquine toxicokinetics. CASE REPORT: A 20-year-old woman (60 kg) presented 1 h after ingesting 36 g of hydroxychloroquine. Vital signs were: BP, 66 mmHg/palpation; heart rate, 115/min; respirations 18/min; oxygen saturation, 100% on room air. She was immediately given intravenous fluids and intubated. Infusions of diazepam and epinephrine were started. Activated charcoal was administered. Her initial serum potassium of 5.3 mEq/L decreased to 2.1 mEq/L 1 h later. The presenting electrocardiogram (ECG) showed sinus tachycardia at 119 beats/min with a QRS duration of 146 ms, and a QT interval of 400 ms (Bazett's QTc 563 ms). She had four episodes of ventricular tachydysrhythmias requiring cardioversion, electrolyte repletion, and lidocaine infusion. Her blood hydroxychloroquine concentration peaked at 28,000 ng/mL (therapeutic range 500-2000 ng/mL). Serial concentrations demonstrated apparent first-order elimination with a half-life of 11.6 h. She was extubated on hospital day three and had a full recovery. CONCLUSION: We present a massive hydroxychloroquine overdose treated with early intubation, activated charcoal, epinephrine, high dose diazepam, aggressive electrolyte repletion, and lidocaine. The apparent 11.6 hour half-life of hydroxychloroquine was shorter than previously described.


Assuntos
Antimaláricos/farmacocinética , Overdose de Drogas/terapia , Hidroxicloroquina/farmacocinética , Hidroxicloroquina/envenenamento , Antimaláricos/sangue , Antimaláricos/envenenamento , Eletrocardiografia , Feminino , Humanos , Hidroxicloroquina/sangue , Toxicocinética , Adulto Jovem
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