1/5. diagnosis and treatment of an unusual cause of metabolic acidosis: ethylene glycol poisoning.ethylene glycol intoxication is a rare but dangerous type of poisoning. It causes a severe acidosis with high anion and osmolal gaps. Clinical manifestations of the ethylene glycol intoxication can be divided in three phases: a neurologic stage, with hallucinations, stupor and coma; the second stage is cardiovascular with cardiac failure. Renal failure characterizes the third stage, due to acute tubular necrosis. After aggressive gastric emptying, the main treatment is ethanol or 4-methypyrazole, which can be given either orally or intravenous, with supportive measures for all symptoms or diseased organ.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/5. Hyperosmolality: another indication for hemodialysis following acute ethylene glycol poisoning.When given early, fomepizole has demonstrated an effective role in the treatment of ethylene glycol (EG) intoxication, often eliminating the need for hemodialysis (HD). Many indications for HD have been suggested for EG intoxication. We present a case of EG intoxication with the second highest reported EG concentration. Despite early treatment with fomepizole and without the development of acidosis or renal insufficiency, the patient required HD for hyperosmolality and subsequent electrolyte imbalances. Indications for HD following EG intoxication are discussed.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/5. Reduced or absent serum anion gap as a marker of severe lithium carbonate intoxication.Two patients with life-threatening lithium carbonate intoxication (serum levels, greater than 4 mEq/L [greater than 4 mmol/L]) presented with a reduced or absent serum anion gap. In both subjects, hemodialysis simultaneously removed the excess lithium ion and normalized the anion gap. Conversely, the anion gap was normal in subjects with therapeutic serum lithium ion levels. Severe lithium carbonate intoxication should be added to the category of illnesses (multiple myeloma, bromide intoxication) causing a marked reduction in the anion gap. In the comatose patient, a reduced anion gap may serve as an important clinical clue to the presence of this drug intoxication.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
4/5. Toxicity of combined therapy with carbonic anhydrase inhibitors and aspirin.A 67-year-old woman and a 75-year-old woman taking carbonic anhydrase inhibitors for therapy of glaucoma and high doses of aspirin for therapy of arthritis developed severe acid-base imbalance and salicylate intoxication. Neither patient exhibited ill effects when taking high aspirin doses without carbonic anhydrase inhibitor. Carbonic anhydrose inhibitor-induced acidemia increases the risk of developing salicylate intoxication in patients receiving high aspirin doses.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/5. systemic inflammatory response syndrome caused by chronic salicylate intoxication.systemic inflammatory response syndrome (SIRS) is characterized by body temperature abnormalities, tachypnea or hyperventilation, tachycardia, and leukocytosis or leukopenia. Although it is typically associated with a serious infection and referred to as sepsis, SIRS can stem from noninfectious causes, as well. We report the cases of four patients with toxic serum levels of salicylate (33.5 to 67.6 mg/dL) and SIRS, and we discuss mechanisms responsible for SIRS. Our patients showed temperature disturbances (35.5 degrees C to 39.8 degrees C), noncardiogenic pulmonary edema, and mixed acid base disturbances. Other abnormalities included coagulopathy (disseminated intravascular coagulation), encephalopathy, and hypotension. All four patients recovered from SIRS, probably due to early recognition and treatment; only one patient did not survive the hospitalization. Chronic salicylate toxicity should be considered as a cause of SIRS in the absence of a source of infection, since survival appears to be dependent on prompt diagnosis and management.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |