1/6. Aborted sudden death, transient Brugada pattern, and wide QRS dysrrhythmias after massive cocaine ingestion.Although cocaine is one of the leading causes of drug-related deaths, there is little clinical information describing the precise sequence of events leading to death in the cocaine intoxication. Usually, cocaine-related sudden deaths are unwitnessed, its electrocardiographic features are not attainable, and the majority of these patients have a rapidly fatal course and die before arriving at the hospital. We report a patient with massive cocaine ingestion who developed psychomotor agitation and generalized seizures followed by asystolic cardiac arrest. ventilation with supplemental oxygen by endotracheal intubation immediately restored spontaneous heart beat. After resuscitation, a severe metabolic acidosis (pH 6.65) and cardiac dysrrhythmias consistent with sodium channel poisoning were detected. The electrocardiogram showed accelerated junctional rhythm at 85 beats/min with right bundle branch block and left anterior hemiblock configuration, prolongation of QRS (0.16 sec) and QTc (0.52 sec) intervals, and terminal J wave associated with coved ST-segment elevation in leads V(1) and V(2) resembling the brugada syndrome. sodium bicarbonate administration was quickly followed by normalization of the cardiac conduction disturbances. This article discusses the clinical and electrophysiologic implications of these findings.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/6. association between droperidol use and sudden death in two patients intoxicated with illicit stimulant drugs.Illicit drug intoxication is often a cause of extreme agitation in the emergency department and prehospital settings. Chemical restraint is often required to protect patient as well as health-care providers. droperidol has commonly been used to sedate extremely agitated patients in the emergency department and psychiatric settings. Its safety has been demonstrated in these settings and in patients who's agitation has been attributed to amphetamine toxicity. We present 2 cases of sudden death following the use of droperidol to sedate 1 patient who was extremely agitated secondary to cocaine intoxication and another secondary to phencyclidine intoxication.- - - - - - - - - - ranking = 3keywords = intoxication (Clic here for more details about this article) |
3/6. propranolol intoxication revealing a brugada syndrome.This is the first report of brugada syndrome revealed by beta-blocker intoxication. A 24-year-old healthy man ingested propranolol (2.28 g) to commit suicide. After early gastric lavage, electrolytes, cardiac enzymes, chest X-ray, and echocardiography were normal. Dosages of psychotropic drugs were negative. ECG showed a typical coved-type pattern of brugada syndrome. Follow-up showed partial ECG normalization of the discrete saddleback-type pattern. The ajmaline- test confirmed brugada syndrome. These ECG modifications may be explained by the stabilizing membrane effect of high concentration of propranolol and/or inhibition of ICaL. This case illustrates the possible deleterious effects of beta-blockers in patients with brugada syndrome.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
4/6. Sudden cardiac death in a young woman: tumor of the atrioventricular (AV) node or citalopram intoxication?Atrioventricular (AV) node tumor is a very rare lesion of the cardiac conduction system. Clinically, it is associated with complete AV block and sudden cardiac death, often in apparently healthy young people.We report a case of a 24-year-old woman who developed ventricular fibrillation during sexual intercourse and died before admittance to the hospital. The woman had a medical history of depression and was treated with citalopram.At first, no macroscopic or microscopic pathologic changes were found. Toxicologic analysis showed a toxic level of citalopram in the blood. Further microscopic examination of the cardiac conduction system disclosed a tumor of the AV node. Immunohistochemical staining confirmed endodermal origin in accordance with the latest hypothesis of the pathogenesis of this tumor.It was concluded that this young woman died of cardiac arrhythmia due to the AV tumor and not from citalopram intoxication, as first suspected. This case emphasizes the importance of a microscopic examination of the cardiac conduction system in cases of sudden unexpected death, even in cases with a plausible cause and manner of death at first glance.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
5/6. Homicidal blunt head trauma, diffuse axonal injury, alcoholic intoxication, and cardiorespiratory arrest: a case report of a forensic syndrome of acute brainstem dysfunction.Sudden death can occur in drunk individuals who are severely beaten about the face. The structural basis for this forensic syndrome is unknown. We herein describe the case of an intoxicated 23-year-old man (blood alcohol 234 mg%, 51 mmol/l) who was involved in an altercation and received blows and kicks to his head. A cardiorespiratory arrest occurred during the assault. He was resuscitated in hospital 23 min later but died 90 h after admission of severe ischemic encephalopathy and bronchopneumonia. Postmortem examination revealed diffuse scalp bruising, no evidence of a skull fracture, multiple small hemispheric contusions, severe cerebral edema secondary to ischemic encephalopathy, and axonal swellings in the corpus callosum, subcortical white matter, midbrain, right rostral inferior cerebellar peduncle, and medulla. This case of near sudden death confirms that blunt head trauma sustained during an assault can cause mild diffuse axonal injury. In addition, it is possible that sudden, alcohol intoxication-associated, craniofacial traumatic death is caused by acute dysfunction of the brainstem cardiorespiratory centers, whose capacity to correct potentially fatal dysrhythmias or apnea, induced by injury to their afferent axons, can be compromised by alcohol ingestion.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
6/6. An autopsy case of acute chloroform intoxication after intermittent inhalation for years.A 39-year-old female died shortly after inhalation of chloroform by a saturated towel placed over her face by her lover, who also inhaled and became unconscious. They had inhaled chloroform once or twice a month for about seven years. Fatal level of chloroform was detected in the blood and tissues by gas chromatographic/mass spectrometric analysis. The fragmentation and waviness of cardiomyocytes that indicates hypercontraction, along with the edema and hemorrhage of the lung, shows the presence of acute heart failure possibly caused by arrhythmias or cardiac depression. The unusual numbers of lipofuscin pigments in the heart as well as in the liver may be generated by the chronic use of chloroform.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |