1/18. Chronic intoxication by doxycycline use for more than 12 years.We report the clinical case of a 12-years' intoxication by doxycycline. A patient with a depersonalization and derealization syndrome took 1 g doxycycline per day. In addition to hepatocellular necrosis with cholestasis, nephrotoxicity, leukopenia, anaemia and skin hyperpigmentation he suffered from hitherto unreported adverse cardiac events as intermittent supraventricular tachycardia and sporadic Wenckebach heart block. Despite a long period of self-medication these side-effects were reversible.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/18. Transient global amnesia associated with cardiac arrhythmia and digitalis intoxication.A 54-year-old woman with transient global amnesia (TGA) was found to have digitalis-induced bradyarrhythmia with atrioventricular dissociation. The amnesia cleared only upon resolution of the arrhythmia. Cardiac arrhythmia has been postulated as a cause, but TGA in the setting of cardiac arrhythmia has not been documented previously. Cardiac arrhythmia should be excluded in patients with TGA, and TGA, a syndrome diagnosed on clinical grounds alone, must be recognized as one possible manifestation of treatable, potentially serious cardiac or cerebrovascular disease.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
3/18. Cardiovascular glycoside-like intoxication following ingestion of thevetia nereifolia/peruviana seeds: a case report.Some plants contain glycoside compounds which determine cardiovascular symptoms similar to those observed after acute toxic digoxin administration. The present case report involves a patient who showed important cardiovascular symptoms following the ingestion of thevetia nereifolia/peruviana seeds. About 30 min after ingestion, a 65-year-old man presented with dizziness, giddiness, numbness and a burning sensation, diarrhea, sweating, vomiting and ECG changes. At the time of admission he presented with tremors; his body temperature was 37 degrees C, and blood analysis gave the following results: K 5.6 mEq/l, myoglobin 176 IU, troponin t 0.10 ng/ml, PO2 69 mmHg, PCO2 37.4 mmHg, pH 7.33, HCO3- 19.9 mEq/l, hemoglobin 14.8 g/dl, saturation 92.5%. echocardiography showed a left ventricle with normal global and segmentary contractility. The following days, the patient showed a reduction, until total resolution, of the atrioventricular block and of the alterations of the ST segment. The ectopic beats also resolved; K value before discharge was 4.4 mEq/l. On the third day, the serum levels of digoxin were 0.15 ng/ml. This case report is important because it describes all the cardiovascular and non-cardiovascular signs of glycoside toxicity in an adult patient who accidentally swallowed only two seeds (non-fatal dose) of thevetia.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
4/18. Successful treatment of oleander intoxication (cardiac glycosides) with digoxin-specific Fab antibody fragments in a 7-year-old child: case report and review of literature.A 7-year-old girl presented six hours after ingestion of a yellow oleander seed (thevetia peruviana) with severe emesis, change in colour vision and complete heart block. Initial treatment with phenytoin and isoprenalin infusion led to intermittent supraventricular and ventricular tachycardia. The patient was then treated with two intravenous doses of 190 mg of digoxin-specific Fab antibody fragments (Digibind). Subsequently the patient's rhythm reverted to sinus rhythm and the symptoms resolved within 2 hours. CONCLUSION: administration of digoxin-specific Fab antibody fragments in an otherwise healthy child after oleander intoxication is safe and without adverse reactions.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/18. The electrocardiographic changes in a case of flecainide overdose.flecainide acetate is a new potent class I antiarrhythmic agent. We report serial electrocardiographic changes occurring in a case of flecainide overdose. The initial flecainide serum level was three times greater than the upper therapeutic level. The prolonged electrocardiographic time intervals (PR and QRS) decreased in correlation with falling drug levels. As the case was associated with concomitant alcohol intoxication, we speculate about the protective effect of alcohol in order to explain our patient's benign clinical course.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
6/18. trichloroethylene and cardiac toxicity: report of two consecutive cases.About two consecutive cases of acute intoxication by trichloroethylene, the authors want to point out the possible occurrence of serious disturbances in cardiac conduction which are less frequently described in the literature than disturbances in myocardial excitability.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
7/18. Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments.The case of a 5-year-old girl who survived a near-fatal ingestion of yew plant leaves after treatment with CPR, transcutaneous pacing, and digoxin-specific FAB antibody fragments is presented. Multiple rhythm disturbances, including profound bradycardia, occurred. She required endotracheal intubation, external chest compressions, and application of a transcutaneous pacemaker. Paced cardiac contractions produced a dramatic improvement in her blood pressure and clinical condition. Two empiric injections of digoxin-specific FAB antibody fragments were administered, after which cardiac function and rhythm gradually improved. She was discharged in her normal state of health three days later. Yew leaves and berries contain several alkaloids that can produce fatal conduction disturbances. Transcutaneous cardiac pacemakers may be lifesaving for patients with transient cardiac toxicity from drug or toxin ingestions. In addition, cross-reactivity between digoxin-specific FAB antibodies and the alkaloids in the yew plant may exist and may have therapeutic importance, although this mechanism was unlikely to have helped our patient.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
8/18. Management of acute severe verapamil intoxication.A 41-year-old man ingested 6.8 g of verapamil in a suicide attempt. The patient was severely hypotensive, oliguric, and developed a variety of dysrhythmias. He was also hyperglycemic. The patient was successfully resuscitated with intravenous normal saline, calcium chloride, dopamine, and norepinephrine. A review of the manifestations of verapamil intoxication and suggestions for management are outlined.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
9/18. amiodarone-associated hypothyroidism--a possible cause of digoxin intoxication.The problem of a possible interaction between amiodarone and digoxin is still unsettled. We have recently treated two patients with digoxin intoxication who had received amiodarone for eight and 36 months respectively. Both developed extreme bradycardia requiring temporary pacemakers. The presence of hypothyroidism was confirmed in both cases by laboratory data. Judging by present knowledge concerning the interaction between amiodarone, thyroid function, and digoxin, it is suggested that digoxin intoxication was not the result of its direct interaction with amiodarone. The possibility that amiodarone-induced hypothyroidism precipitated digoxin intoxication seems to be more plausible. Prevention of digitalis toxicity in amiodarone-treated patients would therefore require monitoring of thyroid function every three to six months. Frequent monitoring of digitalis blood levels is also indicated in patients with amiodarone associated hypothyroidism. Early detection of hypothyroidism and digitalis intoxication is necessary in view of the severity of the course of the disease.- - - - - - - - - - ranking = 1.6keywords = intoxication (Clic here for more details about this article) |
10/18. Acute intoxication with verapamil.A healthy 18-year-old man was admitted to our unit two hours after a suicidal ingestion of 2 gm of verapamil. There was mild hypotension, depression of the sinus node, atrioventricular dissociation, changes of repolarization, and first-degree intranodal atrioventricular block (the His bundle electrogram revealed an atrio-His [A-H] interval of 155 msec). Twenty-four hours after ingestion, the patient was well, and the electrocardiogram was completely normal. This case gave us a good opporturnity to study the electrocardiologic effects of a huge oral dose of verapamil on a healthy young heart.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
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