1/13. Severe rhabdomyolysis following massive ingestion of oolong tea: caffeine intoxication with coexisting hyponatremia.A 36-y-o patient with schizophrenia, who had consumed gradually increasing quantities of oolong tea that eventually reached 15 L each day, became delirious and was admitted to a psychiatric hospital. After abstinence from oolong tea his delirium resolved. He was transferred to our hospital when he was discovered to have acute renal failure with hyponatremia (118 mEq/L) and severe rhabdomyolysis (creatine phosphokinase, 227,200 IU/L). On admission rhabdomyolysis had begun to improve despite a worsening of the hyponatremia (113 mEq/L). With aggressive supportive therapy, including hypertonic saline administration and hemodialysis, the patient fully recovered without detectable sequelae. The clinical course suggests that caffeine, which is present in oolong tea, was mainly responsible for the rhabdomyolysis as well as the delirium, although severe hyponatremia has been reported to cause rhabdomyolysis on rare occasions. We hypothesize that caffeine toxicity injured the muscle cells, which were fragile due to the potassium depletion induced by the coexisting hyponatremia, to result in unusually severe rhabdomyolysis. The possibility of severe rhabdomyolysis should be considered in a patient with water intoxication due to massive ingestion of caffeine-containing beverages.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/13. Acute encephalopathy due to aluminum toxicity successfully treated by combined intravenous deferoxamine and hemodialysis.Acute aluminum intoxication is uncommon in clinical practice but can be fatal. This limited experience is reflected in the paucity of data assessing a viable approach to the treatment of these patients. In this report, the authors describe the clinical course and successful, pharmacokinetic-based deferoxamine-hemodialysis treatment regimen of a patient with severe aluminum encephalopathy following alum bladder irrigation. The combined use of deferoxamine and appropriately timed hemodialysis appears to be a very reasonable means of treating patients with severe acute aluminum intoxication.- - - - - - - - - - ranking = 0.4keywords = intoxication (Clic here for more details about this article) |
3/13. Donepezil for anticholinergic drug intoxication: a case report.We present a case of delirium due to amitriptyline overdose, which resolved rapidly following initiation of the cholinesterase inhibitor donepezil. The authors discuss the possibility of cholinesterase inhibitors being an effective choice in the management of anticholinergic drug induced delirium.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
4/13. delirium and extrapyramidal symptoms due to a lithium-olanzapine combination therapy: a case report.We report an elderly patient who developed severe delirium and extrapyramidal signs after initiation of lithium-olanzapine combination. On hospital admission, serum levels of lithium were found to be 3.0 mM/L which were far above toxic level. Immediate discontinuation of both drugs resulted in complete resolution of most of the symptoms except for perioral dyskinesia which persisted for three more months. We critically discussed the differential diagnosis of lithium intoxication and assessed confounding factors which induce delirium and extrapyramidal signs related with combination therapy of lithium and olanzapine.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
5/13. Prolonged delirium without anticholinergic signs following amitriptyline overdose.In a case of acute intoxication with a tricyclic antidepressant (amitriptyline) delirium was prolonged without there being prominent peripheral anticholinergic or electrocardiographic signs. Administration of physostigmine, repeated when necessary, reversed the delirium.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
6/13. The course of delirium due to lithium intoxication.Nine delirious patients suffering from lithium intoxication were examined with the Mini-Mental State Exam (MMS) to describe the clinical course of the disorder. Serial serum lithium levels were also obtained. serum lithium levels fell rapidly, but the cognitive impairment associated with the delirium typically persisted for another week or two. Late-developing but self-limiting neuropsychiatric complications occurred in four patients. The basis of the temporal dissociation of serum lithium levels from the clinical manifestations of lithium intoxication remains uncertain.- - - - - - - - - - ranking = 1.2keywords = intoxication (Clic here for more details about this article) |
7/13. cocaine intoxication, delirium, and death in a body packer.The authors described a case of emergency department of presentation of acute cocaine delirium in a cocaine "body packer," ie, an individual who attempted to smuggle cocaine by intracorporeal means. Treatment for cocaine intoxication was not initiated because of patient gave a false history; did not present with seizures, stupor or coma; had no deterioration in vital signs until late in the presentation; and presented with apparent psychiatric symptomatology, ie, delirium. delirium should be treated by first identifying its cause and by attempting to remove the cause by appropriate medical and surgical techniques.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
8/13. delirium probably induced by clarithromycin in a patient receiving fluoxetine.BACKGROUND: clarithromycin is a macrolide antibiotic very similar to erythromycin in structure and spectrum of activity. It has gained increasing use since its release in canada in May 1992, partly because it is promoted as having less potential for drug interactions and adverse effects. However, as with all new medications, a high degree of vigilance for unreported adverse effects is advisable. CASE SUMMARY: A healthy 53-year-old lawyer was receiving long-term fluoxetine 80 mg hs and nitrazepam 10 mg hs for depression and mild sleep apnea. Subsequent to initiation of treatment with clarithromycin for a respiratory infection, he rapidly developed delirium, which cleared quickly after stopping all 3 medications. The delirium and psychosis did not recur when the infection was treated with erythromycin alone or after restarting fluoxetine and nitrazepam therapy at previous dosages in the absence of antibiotics. DISCUSSION: This man's delirium is consistent with fluoxetine intoxication, which appears to have resulted from inhibition of hepatic cytochrome P450 metabolism by clarithromycin. Undiagnosed, this serious drug reaction could have lead to serious medical and social consequences. CONCLUSIONS: As the use of clarithromycin increases, the potential for interactions with other drugs metabolized by the P450 enzyme system may be realized. Clinicians should consider which other medications a patient is receiving before prescribing clarithromycin or any macrolide antibiotic with potential to influence the P450 system.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
9/13. Angel's Trumpet psychosis: a central nervous system anticholinergic syndrome.The authors warn physicians that intoxication by Angel's Trumpet (datura sauveolens) is becoming more frequent due to its use by adolescents and young adults as a legal, readily available hallucinogen. Ingestion of Angel's Trumpet flowers or a tea brewed from them results in an alkaloid-induced central nervous system anticholinergic syndrome characterized by symptoms such as fever, delirium, hallucinations, agitation, and persistent memory disturbances. Severe intoxication may cause flaccid paralysis, convulsions, and death. Treatment with intravenous physostigmine reverses the toxic effects of Angel's Trumpet.- - - - - - - - - - ranking = 0.4keywords = intoxication (Clic here for more details about this article) |
10/13. Accidental chronic salicylate intoxication in an elderly patient: major morbidity despite early recognition.Chronic salicylate intoxication represents an unappreciated form of self-poisoning in the elderly and therefore poses a diagnostic challenge. This report describes an elderly female with chronic salicylism who presented with unexplained delirium, dysarthria, diminished short-term memory and hearing, and urinary and fecal incontinence. She was treated with intravenous hydration, urinary alkalinization, and subsequent hemodialysis for persistent aciduria, acidemia and impending circulatory collapse. Major morbidity included myocardial infarction, life-threatening dysrhythmias, and mixed bacterial urosepsis. This report highlights the need to maintain a high index of suspicion for salicylate poisoning in the elderly, who commonly present with nonfocal neurologic features.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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