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https://www.readbyqxmd.com/read/28096230/haemodialysis-in-acute-paracetamol-poisoning
#1
L Serjeant, J Evans, F Sampaziotis, W G Petchey
A woman aged 23 years presented late with clinical and biochemical features of a life-threatening paracetamol (acetaminophen) overdose. Despite instigating N-acetylcysteine treatment, due to evidence of mitochondrial dysfunction together with an exceedingly high paracetamol level, the decision was made to dialyse the patient acutely to remove the parent drug. This was highly effective, and with on-going supportive care, the patient made a full recovery without the need for transplantation. This case highlights the role of extracorporeal therapy as a treatment option in selected cases of paracetamol overdose, consistent with the international guidelines...
January 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28076550/suicide-in-university-students-in-bogot%C3%A3-colombia-2004-2014
#2
Saúl Alonso Franco, Martha Lucia Gutiérrez, Julián Sarmiento, Decsy Cuspoca, Javier Tatis, Alejandro Castillejo, Miguel Barrios, Magnolia Del Pilar Ballesteros-Cabrera, Sara Zamora, Carlos Iván Rodríguez
We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 - 2014). Of these, 69% occurred in males and 31% in females...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28074520/assessing-the-accuracy-of-opioid-overdose-and-poisoning-codes-in-diagnostic-information-from-electronic-health-records-claims-data-and-death-records
#3
Carla A Green, Nancy A Perrin, Shannon L Janoff, Cynthia I Campbell, Howard D Chilcoat, Paul M Coplan
PURPOSE: The purpose of this study is to assess positive predictive value (PPV), relative to medical chart review, of International Classification of Diseases (ICD)-9/10 diagnostic codes for identifying opioid overdoses and poisonings. METHODS: Data were obtained from Kaiser Permanente Northwest and Northern California. Diagnostic data from electronic health records, submitted claims, and state death records from Oregon, Washington, and California were linked. Individual opioid-related poisoning codes (e...
January 10, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28064509/acute-salicylate-poisoning-risk-factors-for-severe-outcome
#4
Rachel M Shively, Robert S Hoffman, Alex F Manini
CONTEXT: Salicylate poisoning remains a significant public health threat with more than 20,000 exposures reported annually in the United States. OBJECTIVE: We aimed to establish early predictors of severe in-hospital outcomes in Emergency Department patients presenting with acute salicylate poisoning. METHODS: This was a secondary data analysis of adult salicylate overdoses from a prospective cohort study of acute drug overdoses at two urban university teaching hospitals from 2009 to 2013...
January 9, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28035699/lack-of-respiratory-depression-in-paracetamol-codeine-combination-overdoses
#5
Simon P E Heppell, Geoffrey K Isbister
BACKGROUND: Codeine containing analgesics are commonly taken in overdose, but the frequency of respiratory depression is unknown. We investigated whether paracetamol-codeine combination overdoses caused respiratory depression more than paracetamol alone. METHODS: We reviewed deliberate self-poisoning admissions with paracetamol (>2 g) and paracetamol-codeine combinations presenting to a tertiary toxicology unit (1987-2013). Demographic information, clinical effects, treatment (naloxone, length of stay[LOS], mechanical ventilation) were extracted from a prospective database...
December 30, 2016: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27992785/identification-of-novel-psychoactive-substances-25b-nbome-and-4-cmc-in-biological-material-using-hplc-q-tof-ms-and-their-quantification-in-blood-using-uplc-ms-ms-in-case-of-severe-intoxications
#6
Marek Wiergowski, Justyna Aszyk, Michał Kaliszan, Kamila Wilczewska, Jacek Sein Anand, Agata Kot-Wasik, Zbigniew Jankowski
This paper describes cases of poisoning caused by new psychoactive substances such as: 25B-NBOMe (2-(4-bromo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine) and 4-CMC (1-(4-chlorophenyl)-2-(methylamino)-1-propanone). The analytical procedure includes rapid and selective method for the extraction and determination of 4-CMC and 25B-NBOMe in blood samples using UPLC-MS/MS technique. To the best of our knowledge, this is the first report, that involves a fully validated method for quantification of new-designer drug - 4-CMC in postmortem blood samples...
January 15, 2017: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
https://www.readbyqxmd.com/read/27986618/recurrent-episodes-of-life-threatening-vasodilatory-shock-following-unintentional-intoxication-with-amlodipine
#7
Chris J Kapelios, George Karamanakos, Stavros Liatis, Magda Sarafadi, Marios Polizois, Ioannis Papoutsis, Alexander D Kokkinos
Calcium channel blockers (CCBs) have a narrow therapeutic index, and their intake in excess is associated with a critical clinical presentation of sustained hypotension and non-cardiogenic pulmonary edema, which are difficult to treat. Unfortunately, available means of treatment fail to resuscitate a significant number of patients poisoned by CCBs, rendering them the main cardiovascular drugs involved in deaths due to overdose. Importantly, in all cases reported until now in the literature, CCB intoxication was known at the time of the patients' presentation and the medical challenge regarded solely the therapeutic approach...
December 13, 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/27984346/an-examination-of-claims-based-predictors-of-overdose-from-a-large-medicaid-program
#8
Gerald Cochran, Adam J Gordon, Wei-Hsuan Lo-Ciganic, Walid F Gellad, Winfred Frazier, Carroline Lobo, Chung-Chou H Chang, Ping Zheng, Julie M Donohue
BACKGROUND: Health systems may play an important role in identification of patients at-risk of opioid medication overdose. However, standard measures for identifying overdose risk in administrative data do not exist. OBJECTIVE: Examine the association between opioid medication overdose and 2 validated measures of nonmedical use of prescription opioids within claims data. RESEARCH DESIGN: A longitudinal retrospective cohort study that estimated associations between overdose and nonmedical use...
December 15, 2016: Medical Care
https://www.readbyqxmd.com/read/27932048/fatal-intravenous-injection-of-potassium-is-postmortem-biochemistry-useful-for-the-diagnosis
#9
Cristian Palmiere, Maria Pia Scarpelli, Vincent Varlet, Pia Baumann, Katarzyna Michaud, Marc Augsburger
Fatal cases of potassium overdoses have traditionally been considered indemonstrable due postmortem biochemical investigation limits (mainly potassium determination in postmortem serum and vitreous humor). Nevertheless, some authors have expressed a divergent opinion over the years based on the results of their own investigations. In this study, we investigated left vitreous, right vitreous, postmortem serum from peripheral blood, postmortem serum from cardiac blood, urine, pericardial and cerebrospinal fluid potassium concentrations in 21 forensic autopsy cases...
November 27, 2016: Forensic Science International
https://www.readbyqxmd.com/read/27898722/suicide-among-young-people-and-adults-in-ireland-method-characteristics-toxicological-analysis-and-substance-abuse-histories-compared
#10
Ella Arensman, Marco Bennardi, Celine Larkin, Amanda Wall, Carmel McAuliffe, Jacklyn McCarthy, Eileen Williamson, Ivan J Perry
OBJECTIVE: Information on factors associated with suicide among young individuals in Ireland is limited. The aim of this study was to identify socio-demographic characteristics and circumstances of death associated with age among individuals who died by suicide. METHODS: The study examined 121 consecutive suicides (2007-2012) occurring in the southern eastern part of Ireland (Cork city and county). Data were obtained from coroners, family informants, and health care professionals...
2016: PloS One
https://www.readbyqxmd.com/read/27889404/adolescent-suicidal-ingestion-national-trends-over-a-decade
#11
David C Sheridan, Robert G Hendrickson, Amber L Lin, Rongwei Fu, B Zane Horowitz
PURPOSE: Suicide attempts by adolescents most commonly involve the overdose of medications. To date, there has been little information on the over-the-counter or prescription medicines that adolescents ingest for self-harm. Identification of medications chosen in suicide attempts may help guide anticipatory guidance to parents by primary care providers and Poison Centers in prevention programs. METHODS: This was a retrospective observational study using the American Association of Poison Control Center's National Poison Data System...
November 23, 2016: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/27884585/the-successful-treatment-of-5-fluorouracil-5-fu-overdose-in-a-patient-with-malignancy-and-hiv-aids-with-uridine-triacetate
#12
Cynthia Santos, Brent W Morgan, Robert J Geller
According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n=135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived...
November 15, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27876395/massive-lamotrigine-poisoning-a-case-report
#13
Salvatore Grosso, Silvia Ferranti, Carla Gaggiano, Elisabetta Grande, Barbara Loi, Rosanna Di Bartolo
Lamotrigine (LTG) represents the most commonly prescribed of the so-called new generation antiepileptic drugs. We describe a child who was admitted to the emergency room because of generalized tonic-clonic status epilepticus followed by a complex neurological picture with hyperkinesia and acute ataxia as a result of a LTG intoxication. The experience on acute LTG intoxication is very limited in pediatrics. The present case provides information on the clinical picture related to LTG overdose and confirms that drug intoxications should be considered in the differential diagnosis strategy when severe and polymorphic neurological symptoms occur acutely...
November 19, 2016: Brain & Development
https://www.readbyqxmd.com/read/27876104/a-cohort-study-of-unstable-overdose-patients-treated-with-intravenous-lipid-emulsion-therapy
#14
Shazma Mithani, Kathryn Dong, Ashlea Wilmott, Heather Podmoroff, Nadim Lalani, Rhonda J Rosychuk, Ryan Chuang, Mark C Yarema
OBJECTIVES: Intravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered. METHODS: Consecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014...
November 23, 2016: CJEM
https://www.readbyqxmd.com/read/27845815/%C3%A3-verdosering-av-paracetamol-med-modifierad-fris%C3%A3-ttning-%C3%A3-kar-etablerad-behandlingsregim-med-n-acetylcystein-otillr%C3%A3-cklig-%C3%A2-giftinformationscentralen-ger-ut-nya-behandlingsr%C3%A3-d
#15
Jonas Höjer, Helene Salmonson, Gunilla Sjöberg, Markus Tellerup, Jacob Brogren
Overdose of modified-release paracetamol calls for changed treatment routines. New guidelines from the Swedish Poisons Information Centre  The sales of modified-release paracetamol tablets are steadily increasing in Sweden as are the number of overdose cases with this formulation. The Swedish Poisons Information Centre has noted that the standard treatment protocol with N-acetylcysteine (NAC), which is based on overdoses with immediate-release paracetamol formulations, is often inadequate in this setting. In this paper, an adult who overdosed on 66...
November 10, 2016: Läkartidningen
https://www.readbyqxmd.com/read/27830905/-drug-safety-associated-with-the-change-of-digitalis-drug-in-norway
#16
Christian Haga, Mimi Stokke Opdal, Silja Skogstad Tuv, Per Henrik Zahl, Hanne Stenberg-Nilsen
BACKGROUND In 2011, following a period with delivery problems, the only registered digitoxin drug in Norway was replaced with digoxin. As a result, approximately 21 000 patients had to replace digitoxin with digoxin. There are important pharmacokinetic differences between digitoxin and digoxin (the general term for both drugs is digitalis), which must be taken into account when changing therapy. The aim of this study was to investigate compliance of drug security, during the transition from digitoxin to digoxin in Norway...
November 2016: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
https://www.readbyqxmd.com/read/27810724/age-related-differences-in-self-harm-presentations-and-subsequent-management-of-adolescents-and-young-adults-at-the-emergency-department
#17
Emma Diggins, Rachael Kelley, David Cottrell, Allan House, David Owens
BACKGROUND: Characteristics of self-harm differ across ages, but there is little work identifying age-related differences in younger people. Young people entering adolescence face emotionally and developmentally different challenges to those entering adulthood. This study investigates how Emergency Department (ED) presentations and management of self-harm differ through adolescence and early adulthood. METHODS: 3782 consecutive self-harm episodes involving 2559 people aged 12-25 years were identified from an existing database of Leeds ED attendances from 2004 to 2007...
January 15, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/27788602/can-a-serum-acetaminophen-concentration-obtained-less-than-4-hours-post-ingestion-determine-which-patients-do-not-require-treatment-with-acetylcysteine
#18
Mark C Yarema, Jason P Green, Marco L A Sivilotti, David W Johnson, Alberto Nettel-Aguirre, Charlemaigne Victorino, Daniel A Spyker, Barry H Rumack
CONTEXT: The interpretation of acetaminophen concentrations obtained prior to 4 hours after an acute, single overdose remains unclear. Patient care decisions in the Emergency Department could be accelerated if such concentrations could reliably exclude the need for treatment. OBJECTIVE: To determine the agreement between a serum acetaminophen concentration obtained less than 4 hours after an acute ingestion and the subsequent 4 + hour concentration, and the predictive accuracy of early concentrations for identifying patients with potentially toxic exposures...
October 28, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27788591/chloroform-ingestion-causing-severe-gastrointestinal-injury-hepatotoxicity-and-dermatitis-confirmed-with-plasma-chloroform-concentrations
#19
Dushan Jayaweera, Shawkat Islam, Naren Gunja, Chris Cowie, James Broska, Latesh Poojara, Michael S Roberts, Geoffrey K Isbister
CONTEXT: Poisoning due to chloroform ingestion is rare. The classic features of acute chloroform toxicity include central nervous system (CNS) and respiratory depression, and delayed hepatotoxicity. CASE DETAILS: A 30-year-old female ingested 20-30 mL of 99% chloroform solution, which caused rapid loss of consciousness, transient hypotension and severe respiratory depression requiring endotracheal intubation and ventilation. She was alert by 12 h and extubated 16 h post-overdose...
February 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/27785820/central-nervous-system-toxicity-of-mefenamic-acid-overdose-compared-with-other-nsaids-an-analysis-of-cases-reported-to-the-united-kingdom-national-poisons-information-service
#20
Ashraf Kamour, Siobhan Crichton, Gill Cooper, David J Lupton, Michael Eddleston, J Allister Vale, John P Thompson, Simon H L Thomas
AIMS: Case reports and small case series suggest increased central nervous system (CNS) toxicity, especially convulsions, after overdose of mefenamic acid, compared with other nonsteroidal anti-inflammatory drugs (NSAIDs), although comparative epidemiological studies have not been conducted. The current study compared rates of CNS toxicity after overdose between mefenamic acid, ibuprofen, diclofenac and naproxen, as reported in telephone enquiries to the UK National Poisons Information Service (NPIS)...
October 26, 2016: British Journal of Clinical Pharmacology
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