Fatal adverse event secondary to high osmolality contrast agent.

Adverse drug events secondary to iodinated contrast agents are of particular concern to all clinicians. Despite the availability of newer agents, the mortality rates remain unchanged. We describe a fatal adverse event secondary to use of the high osmolality agent iothalmate meglumine 30%. A 58-y-old healthy female with no previous history of drug or food allergy had cardiac arrest toward the end of the i.v. infusion of the contrast agent during a CT scan. The patient expired despite aggressive therapeutic measures.

Methamphetamine overdose: experience with six cases.

We describe experience with 6 cases of methamphetamine overdose. Because of its low cost, easy availability and longer duration of action compared to cocaine, methamphetamine has become the drug of choice in various communities. Marked change in mental status was observed in all of our patients. One patient had a myocardial infarction that responded well to thrombolytic therapy. Clinicians should be familiar with the medical effects and treatment of acute methamphetamine toxicity.

Respiratory distress secondary to both amphotericin B deoxycholate and lipid complex formulation.

A 73-y-old female with a history of adenocarcinoma of colon and refractory anemia developed febrile neutropenia following chemotherapy. Therapy with iv infusion of amphotericin B deoxycholate (AmBd) was initiated on day 8 of hospital admission. Premedications included acetaminophen, diphenhydramine and meperidine. Patient developed rigor, chill and elevated temperature approximately 100 min into the infusion. The infusion was temporarily discontinued and rigors subsided following administration of 25 mg meperidine im. Infusion was continued after cessation of the rigors with no further sequelae. During each infusion of AmBd over the next 3 d, the patient developed rigor, chill and elevated temperature which was managed with meperidine. However, on day 4 she developed respiratory distress, bronchospasm and visible cyanosis with oxygen saturation of 88% while on 2 L oxygen. The infusion was stopped and the symptoms subsided with administration of albuterol via nebulizer. Amphotericin lipid formulation infusion was reinstituted after 3 d because of the patient's worsening clinical status. However, the patient developed severe respiratory distress approximately 130 min into the infusion. The infusion was discontinued and she was treated with albuterol via nebulizer. Itraconazole therapy was instituted without any adverse sequelae. Clinicians should be aware of this potential adverse event since it can occur with all formulation of amphotericin.

Myoclonus secondary to the concurrent use of trazodone and fluoxetine.

A 39-y-o male with a history of human immunodeficiency virus infection and depression was admitted for diagnosis and treatment of tuberculosis and pneumocystis carinii pneumonia infections. Prior to admission, he was on 50 mg trazodone every evening for 2 mo for depression. He was admitted with a 2-w history of fever chills and fatigue and on admission had hand tremors which disappeared at rest. Four days post-admission the trazodone dose was increased to 100 mg and 20 mg fluoxetine was initiated. He became increasingly anxious and his hand tremor worsened 3 d after initiation of the regimen. To rule out drug induced tremor, both trazodone and fluoxetine were discontinued and symptoms resolved in 7 d. Clinicians should be aware of the potential for excessive seratonergic activities secondary to trazodone + fluoxetine interactions causing a worsening myoclonus adverse event.