1/16. suicide attempt by pure citalopram overdose causing long-lasting severe sinus bradycardia, hypotension and syncopes: successful therapy with a temporary pacemaker.In few cases, pure citalopram overdose at doses above 600 mg showed electro-cardiographic changes with prolonged QT intervals and sinus bradycardia gradually resolving within 12-24 hours after intoxication. We report on a 32-year-old patient with borderline personality disorder (BPD) who ingested a total of 800 mg citalopram to attempt suicide due to an interpersonal disappointment. She developed severe sinus bradycardia with a minimal pulse rate of 41/min within about 4 hours after intoxication lasting up to six days during intensive care unit (ICU) treatment. Further, hypotension and syncopes occurred. No QT interval prolongations were recorded. To our knowledge, this is the first case report of pure citalopram overdose-induced long-lasting sinus bradycardia associated with severe hypotension and intermittent syncopes that required therapy with a temporary pacemaker.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/16. Cardiovascular depression resulting from atenolol intoxication.A case of massive atenolol ingestion leading to hypotension in association with PR and QRS interval prolongation on the electrocardiogram is presented. These clinical findings are identical to those attributed to the membrane-stabilizing activity of propranolol and other lipophilic beta-blockers. It is commonly believed that hydrophilic agents such as atenolol lack this activity. A review of the literature reveals that hydrophilic beta-blockers may have membrane-stabilizing activity, though much higher concentrations are required to produce this action in comparison with lipophilic agents. This case and a review of the literature provides a potential pathophysiological basis for atenolol-induced haemodynamic depression.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/16. The elucidation of epinephrine as an antihypotensive agent in abamectin intoxication.Abamectin (ABM) has been used in some suicidal attempt cases in recent years. ABM-intoxicated patients demonstrate low mean arterial pressure (MAP) and commonly treated with catecholamine to burst maps in their intensive cares. This investigation examined roles of epinephrine on MAP, heart rate (HR), and therein baroreflex sensitivity (BRS = HR/MAP) during ABM intoxication in rats. Oral application of ABM (20 mg/kg) induced an increase in HR and BRS accompanied by a decrease in MAP. These effects, except for on BRS, were abolished by concomitant epinephrine injection [100 microg/ kg, subcutaneously (s.c.)]. ABM also induced an increase in serum nitric oxide levels, which was partly antagonized by epinephrine. In summary, oral application of ABM induced a decrease in MAP. Administration of epinephrine sustained the normal range of MAP via nitric oxide regulation, but it has no effect on BRS due to the synchronous changes of MAP and HR in ABM-intoxicated rats.- - - - - - - - - - ranking = 2.5keywords = intoxication (Clic here for more details about this article) |
4/16. Easily reversible hypoxemia and hypotension induced by nimodipine.Calcium antagonists are drugs commonly prescribed for the treatment of hypertension, angina pectoris, cardiac arrhythmias and other disorders because of their efficacy and tolerability. Nevertheless, overdosage and intoxication are well documented. In this paper we report a case of nimodipine overdosage resulting in prolonged hypotension and hypoxemia, which was successfully treated with calcium gluconate.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
5/16. Delayed dystonia following pimozide overdose in a child.BACKGROUND: pimozide overdose has rarely been reported in children. In adults, pimozide intoxication may cause seizures, extrapyramidal and anticholinergic effects, hypotension, QTc prolongation and torsades de pointes. We report dystonia, hypotension and drowsiness following pimozide ingestion in a child. CASE REPORT: An alert 18-month-old presented to hospital 40 minutes after ingesting up to 6 mg (0.5 mg/kg) of pimozide. vital signs: BP 91/62 mmHg, HR 130/min, RR 26/min, temperature 97.2 degrees F (36.2 degrees C). She received gastric lavage and activated charcoal. One hour later, her QTc interval was 420 msec, HR 150. She remained asymptomatic until 12 hours post-ingestion, when she developed drooling, tongue thrusting and drowsiness. BP was 75/40, HR 150, QTc 440 msec. BP increased to 95/50 after a bolus of normal saline. Her dystonia subsided over the next 12 hours without treatment. Drowsiness and tachycardia persisted until 40 hours post-ingestion. QTc interval at this time was 370 msec. Patient recovered without sequelae. CONCLUSION: pimozide overdose in children may be associated with delayed onset of symptoms, including dystonia.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
6/16. Near-fatal amitraz intoxication: the overlooked pesticide.Amitraz is commonly used in agricultural industries throughout the world as a farm-animal insecticide. Despite its widespread use, amitraz intoxication is extremely rare and mainly occurs through accidental ingestion by young children. Severe, life-threatening amitraz intoxication in adults is very rarely recognized and reported. Described herein is a previously healthy 54-year-old patient who accidentally ingested a mouthful of liquid amitraz concentrate, and rapidly developed life-threatening clonidine-like overdose syndrome, manifested as nausea, vomiting, hypotension, bradycardia, bradypnoea, and deep coma. Supportive treatment, including mechanical ventilation, and atropine administration resulted in full recovery within 48 hr. Very few cases of near-fatal amitraz poisoning in adults have been described in the medical literature, leading to low awareness of physicians in general practice to the potential toxicity of amitraz. As a consequence, cases of amitraz poisoning are not recognised and therefore erroneously treated as the much more commonly recognized organophosphate and carbamate intoxication. In our discussion, we review the clinical and laboratory manifestations of amitraz poisoning, including clinical hints that aid in the recognition of this often-overlooked diagnosis. Differentiation of amitraz intoxication from the much more commonly seen pesticide-related organophosphate and carbamate intoxication is of utmost importance, in order to avoid erroneous, unnecessary, and often dangerous treatment.- - - - - - - - - - ranking = 4.5keywords = intoxication (Clic here for more details about this article) |
7/16. fever, hyperdynamic shock, and multiple-system organ failure. A pseudo-sepsis syndrome associated with chronic salicylate intoxication.OBJECTIVE: To describe a sepsis-like syndrome associated with chronic salicylate intoxication. DESIGN: Retrospective clinical study. SETTING: University-affiliated county hospital. patients: Five patients who became accidentally intoxicated while ingesting salicylates on a long-term daily basis. RESULTS OF DATA ANALYSIS: All five salicylate-intoxicated patients had clinical and laboratory features that were highly suggestive of sepsis, but no bacteriologic or pathologic evidence of infection could be documented. Features included fever, leukocytosis with increased band forms, hypotension with a reduced SVR and multiple system organ failure (ARDS, encephalopathy, renal failure, and DIC). A diagnosis of salicylate intoxication was made at the time of admission to the hospital in only one case. In the other four cases, the presumptive diagnosis was sepsis; a correct diagnosis of salicylate intoxication was not established until between 16 h and 10 days after admission in these four cases. Two patients died, one patient required permanent hemodialysis, and two patients recovered fully only after prolonged and complicated hospitalizations. The pathogenesis of this syndrome is uncertain. In two cases, serum levels of TNF-alpha, IL-1 beta and IL-6 were measured by ELISA. In both cases serum IL-6 was markedly increased, and in one case serum TNF-alpha was also elevated. CONCLUSION: Occult salicylate intoxication should be considered when apparent sepsis syndrome occurs without a readily easily identifiable source of infection.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
8/16. poisoning due to ingestion of Veratrum viride (false hellebore).We present six cases of poisoning due to ingestion of Veratrum viride (false hellebore) and review the physiology of veratrum alkaloids. Significant bradycardia and hypotension can occur after intoxication by veratrum plants, which grow widely in swampy areas of the eastern and western united states. nausea and vomiting also occur typically after ingestion. atropine is the mainstay of therapy, but pressors may be required to maintain blood pressure. Cases of veratrum poisoning have not been widely reported in the emergency medicine literature.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
9/16. Substance abuse: clinical identification and management.Substance abuse is a significant health problem in the adolescent population. Prevention is a formidable challenge, but attempts at discouraging experimentation in early adolescence and the promotion of healthy adult role models may be effective strategies. Questions that may elicit a history suggestive of abuse should be a routine part of the adolescent medical history. Pediatricians should be familiar with the important clinical findings resulting from intoxication with the various substances of abuse and should be able to recognize the "telltale" signs of abuse. Effective management is based on attention to the basics of life support, careful attention to the physical findings, and judicious use of specific therapeutic agents. Above all, a compassionate attitude should prevail if acute-phase recovery and long-term rehabilitation are to be successful.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
10/16. 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 = 2.5keywords = intoxication (Clic here for more details about this article) |
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