1/3. Pilsicainide intoxication in a patient with dehydration.An 81-year-old woman developed pilsicainide intoxication associated with dehydration. The patient had been taking pilsicainide (100 mg/day) for 1 year because of paroxysmal atrial fibrillation. Her renal function was within normal limits. One week before admission, she was suffering from pneumonia, and had appetite loss, fever, and severe fatigue. physical examination revealed dehydration. The electrocardiogram (ECG) on admission showed atrioventricular dissociation, idioventricular rhythm with marked QRS widening and QTc prolongation. The plasma concentration of pilsicainide on admission was markedly elevated at 6.2 microg/ml, approximately 6 times the therapeutic range (0.25-1.0 microg/ml). Continuous saline infusion was initiated for the treatment of dehydration,which progressively improved. As a result, sinus rhythm was recovered 2 h after admission, and the QRS and JT intervals gradually normalized. This is an interesting case because the proarrhythmia of pilsicainide was induced by dehydration.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/3. Photopsia as a manifestation of digitalis toxicity.CASE REPORT: To present a case of photopsia resulting from digoxin intoxication brought about by dehydration in a 72-year-old woman. COMMENTS: Ophthalmologists may be the first clinicians to notice the symptoms of digitalis intoxication, which is potentially a life-threatening condition.- - - - - - - - - - ranking = 0.4keywords = intoxication (Clic here for more details about this article) |
3/3. Unstable osmoreceptors and defective thirst in hypothalamic hypopituitarism.An 8-year-old girl with hypothalamic hypopituitarism is described. The clinical course was characterized by fluctuation between diabetes insipidus and water intoxication. In an attempt to find a physiological explanation she underwent two sets of dehydration and osmotic threshold tests. The presence of endogenous vasopressin, and the normally functioning volume receptors, was demonstrated by the normal urine osmolality during dehydration. The osmotic threshold was 263 mosm/kg on one test and 300 mosm/kg on the other. More extreme values might be suspected based on simultaneous urine and plasma osmolality obtained during acute episodes of water intoxication and severe dehydration. With plasma osmolality as high as 307 mosm/kg, the child denied thirst. The data appear to indicate an instability of the osmoreceptor mechanism and a deficiency of the thirst mechanism with intact volume receptors.- - - - - - - - - - ranking = 0.4keywords = intoxication (Clic here for more details about this article) |