1/5. Accidental iatrogenic intoxications by cytotoxic drugs: error analysis and practical preventive strategies.OBJECTIVES: Drug errors are quite common. Many of them become harmful only if they remain undetected, ultimately resulting in injury to the patient. Errors with cytotoxic drugs are especially dangerous because of the highly toxic potential of the drugs involved. For medico-legal reasons, only 1 case of accidental iatrogenic intoxication by cytotoxic drugs tends to be investigated at a time, because the focus is placed on individual responsibility rather than on system errors. The aim of our study was to investigate whether accidental iatrogenic intoxications by cytotoxic drugs are faults of either the individual or the system. The statistical analysis of distribution and quality of such errors, and the in-depth analysis of contributing factors delivered a rational basis for the development of practical preventive strategies. methods: A total of 134 cases of accidental iatrogenic intoxication by a cytotoxic drug (from literature reports since 1966 identified by an electronic literature survey, as well as our own unpublished cases) underwent a systematic error analysis based on a 2-dimensional model of error generation. Incidents were classified by error characteristics and point in time of occurrence, and their distribution was statistically evaluated. The theories of error research, informatics, sensory physiology, cognitive psychology, occupational medicine and management have helped to classify and depict potential sources of error as well as reveal clues for error prevention. RESULTS: Monocausal errors were the exception. In the majority of cases, a confluence of unfavourable circumstances either brought about the error, or prevented its timely interception. Most cases with a fatal outcome involved erroneous drug administration. Object-inherent factors were the predominant causes. A lack of expert as well as general knowledge was a contributing element. In error detection and prevention of error sequelae, supervision and back-checking are essential. Improvement of both the individual training and work environment, enhanced object identification by manufacturers and hospitals, increased redundancy, proper usage of technical aids, and restructuring of systems are the hallmarks for error prevention. CONCLUSIONS: Errors follow general patterns even in oncology. Complex interdependencies of contributing factors are the rule. Thus, system changes of the working environment are most promising with regard to error prevention. Effective error control involves adapting a set of basic principles to the specific work environment. The work environment should allow for rectification of errors without penalty. Regular and ongoing intra-organisational error analysis needs to be an integral part of any error prevention strategy. However, it seems impossible to totally eliminate errors. Instead, if the environment guarantees timely error interception, most sequelae are avoided, and errors transform into a system-wide learning tool.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/5. Hospital-acquired salicylate intoxication. report of a case with psychosis, acidosis, and coma.A case of salicylate intoxication from repeated therapeutic doses of aspirin is reported in an adult with impairment of salicylate elimination. Evolution of acid-base disturbance from respiratory alkalosis to metablic acidosis is documented. serum salicylate levels during several years of therapy demonstrate the acquisition of impaired elimination of the drug. This case illustrates the practical importance of special features of salicylate accumulation kinetics emphasized in a recent review.- - - - - - - - - - ranking = 0.71428571428571keywords = intoxication (Clic here for more details about this article) |
3/5. Cardiac arrest following an iatrogenic 3,4-diaminopyridine intoxication in a patient with lambert-eaton myasthenic syndrome.Syndromes with impaired neuromuscular transmission are frequently treated with pyridine derivates. 3,4-diaminopyridine is thought to have fewer side effects than the commonly used, but less potent, 4-aminopyridine. We describe a patient with an initially unrecognized iatrogenic intoxication with 3,4-diaminopyridine. Except for a life threatening arrhythmia, symptoms were similar to a 4-aminopyridine intoxication. The patient made a full recovery with symptomatic treatment and withdrawal of the drug.- - - - - - - - - - ranking = 0.85714285714286keywords = intoxication (Clic here for more details about this article) |
4/5. Iatrogenic bismuth poisoning. Case report.A case of bismuth intoxication following the intraoral use of BIPP-impregnated gauze packs is presented. This report illustrates the need for caution when using potentially toxic compounds in the oral cavity where significant quantities can be absorbed to produce symptoms of poisoning.- - - - - - - - - - ranking = 0.14285714285714keywords = intoxication (Clic here for more details about this article) |
5/5. The use of pamidronate for hypercalcemia secondary to acute vitamin d intoxication.INTRODUCTION: Pamidronate disodium, a bone resorption inhibitor through osteoclast mediation, has been used to treat chronic hypercalcemia secondary to malignancy and chronic renal failure. We report the use of pamidronate for acute, severe hypercalcemia secondary to iatrogenic vitamin d poisoning. CASE REPORT: A 77-year-old female nursing home resident was inadvertently administered 50,000 units of oral vitamin d daily for 6 days. The patient presented with lethargy, abdominal pain, and vomiting. The patient's initial serum calcium concentration was 5.25 mmol/L (21 mg/dL). The patient was initially treated with hydration and furosemide but developed congestive heart failure. Pamidronate was used and calcium concentrations normalized by 24 hours after treatment. CONCLUSION: We report a case of the use of pamidronate for significant hypercalcemia secondary to acute vitamin d poisoning. Although evidence of congestive heart failure was evident, dialysis was avoided without significant sequelae. Pamidronate therapy should be considered in patients with hypercalcemia secondary to acute vitamin d poisoning.- - - - - - - - - - ranking = 0.57142857142857keywords = intoxication (Clic here for more details about this article) |