1/33. Prolonged opioid antagonism with naloxone in chronic renal failure.Respiratory depression secondary to morphine intoxication occurred in an elderly patient with chronic renal failure (CRF). It was reversed with a continuous infusion of naloxone. Approximately 11 hours after the infusion was discontinued, the patient relapsed into respiratory depression consistent with opioid intoxication. He was rechallenged with a naloxone infusion with resolution of the opioid effects. This case suggests prolonged antagonism of opioid effects inconsistent with naloxone's reported pharmacologic effects. serum naloxone concentrations measured after the end of the infusion suggest that the drug's pharmacokinetics were significantly altered. Further research is necessary to characterize pharmacokinetic changes that occur in CRF. In the absence of this information, similar patients should be closely monitored for relapse of respiratory depression after naloxone is discontinued.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/33. The pathophysiology and management of renal bone disease in dialysis patients.As renal function declines, changes in mineral metabolism occur including phosphate retention, calcitriol deficiency, and the development of secondary hyperparathyroidism. Renal bone disease related to disordered mineral metabolism may result in increased patient morbidity and mortality. Uncontrolled parathyroid hormone (PTH) secretion will result in osteitis fibrosa, a high turnover bone disease. The use of calcium and aluminum-based phosphate binders and vitamin d sterols may contribute to the development of low turnover bone diseases such as osteomalacia and aplastic bone disease. Prevention and control of renal bone disease is an important goal for the interdisciplinary health care team. This paper discusses disordered mineral metabolism and its relationship to renal bone disease. Case studies illustrate the development and treatment of renal bone disease related to secondary hyperparathyroidism and aluminum intoxication.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
3/33. Star fruit (Averrhoa carambola) intoxication: an important cause of consciousness disturbance in patients with renal failure.Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. Most cases in the literature are uremic patients on maintenance dialysis. We present a patient with chronic renal failure, who was not on dialysis program yet, suffered from star fruit intoxication with presentation of consciousness disturbance and successfully managed by a session of hemodialysis.- - - - - - - - - - ranking = 3keywords = intoxication (Clic here for more details about this article) |
4/33. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome.BACKGROUND: Clinical symptoms and outcomes of uraemic patients ingesting star fruit are quite variable and may progress to death. The purpose of the present report was to discuss the neurotoxic effects of star fruit intoxication in uraemic patients and to present the efficacy of different therapeutic approaches. methods: We studied a total of 32 uraemic patients who had ingested star fruit. Before the intoxication episodes, 20 patients were on regular haemodialysis, eight were on peritoneal dialysis and four were not yet undergoing dialysis. Two patients were analysed retrospectively from their charts, 17 were directly monitored by our clinic and 13 were referred by physicians from many areas throughout the country, allowing us to follow their outcome from a distance. Intoxicated patients were given different therapeutic approaches (haemodialysis, peritoneal dialysis and supportive treatment), and their outcomes were analysed. RESULTS: The most common symptoms were persistent and intractable hiccups in 30 patients (93.75%), vomiting in 22 (68.7%), variable degrees of disturbed consciousness (mental confusion, psychomotor agitation) in 21 (65.6%), decreased muscle power, limb numbness, paresis, insomnia and paresthesias in 13 (40.6%) and seizures in seven (21.8%). patients who were promptly treated with haemodialysis, including those with severe intoxication, recovered without sequelae. patients with severe intoxication who were not treated or treated with peritoneal dialysis did not survive. CONCLUSIONS: Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue.- - - - - - - - - - ranking = 2.5keywords = intoxication (Clic here for more details about this article) |
5/33. Iron-mobilizing properties of the gadolinium-DTPA complex: clinical and experimental observations.BACKGROUND: gadolinium (Gd) magnetic resonance imaging (MRI) contrast agents are considered to be safe in patients with impaired renal function. Our study investigates a mechanism of severe iron intoxication with life-threatening serum iron levels in a haemodialysis patient following MRI with Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) administration. His previous history was remarkable for multiple blood transfusions and biochemical evidence of iron overload. We hypothesized that Gd-DTPA may have an iron-mobilizing effect in specific conditions of iron overload combined with prolonged exposure to the agent. methods: For the in vitro study, Gd-DTPA was added to mice liver homogenate and iron metabolism parameters were measured after incubation in comparison with the same samples incubated with saline only. For the in vivo study, an experimental model of acute renal failure in iron-overloaded rats was designed. Previously iron-overloaded and normally fed rats underwent bilateral nephrectomy by renal pedicle ligation, followed by Gd-DTPA or saline injection. Iron and iron saturation levels were checked before and 24 h after Gd-DTPA or vehicle administration. RESULTS: Significant mobilization of iron from mice liver tissue homogenate in mixtures with Gd in vitro was seen in the control (saline) and in the experimental (Gd) groups (513 /-99.1 vs 1117.8 /-360.8 microg/dl, respectively; P<0.05). Administration of Gd-DTPA to iron-overloaded rats after renal pedicle ligation caused marked elevation of serum iron from baseline 143 /-3.4 to 570 /-8 microg/dl (P<0.0001). There were no changes of the named parameter, either in iron-overloaded anuric rats after saline injection or in normal diet uraemic animals, following Gd-DTPA administration. CONCLUSIONS: The combination of iron overload and lack of adequate clearance of Gd chelates may cause massive liberation of iron with dangerous elevation of free serum iron. It is highly recommended that after Gd contrast study, end-stage renal disease patients with probable iron overload should undergo prompt and intensive haemodialysis for prevention of this serious complication.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
6/33. Aluminium intoxication in undialysed adults with chronic renal failure.The dialysis encephalopathy syndrome (DES) consists of altered mental status, communication difficulty, seizures and myoclonus. It has been attributed to elevated serum aluminium (A1) levels. Two undialysed patients with chronic renal failure who presented with the characteristic syndrome are reported. The first, a 48 year old female, had used A1 containing phosphate binders for two years. Her serum A1 level was 25.34 mumol/L. Despite treatment with desferoximine and dialysis, she died. Necropsy revealed elevated A1 levels in the cerebral cortex (19 mcg/gm) and spongioform change in the outer three cortical layers. The second patient, a 46 year old woman, had a serum A1 of 8.70 mumol/L. She had never taken A1 containing phosphate binders but had taken several grams/day of citrate for at least six months. Treatment with haemodialysis and discontinuation of the citrate produced a resolution of symptoms and return of the A1 level to normal. During two years of haemodialysis there has been no recurrence.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
7/33. Interactions between clarithromycin and digoxin in patients with end-stage renal disease.OBJECTIVE: To report a significant increase in the serum levels of digoxin associated with the use of clarithromycin in six patients undergoing renal replacement therapy. CASE SUMMARY: All six patients were males with end-stage renal disease and in need of renal replacement therapy. Four patients were anuric. The mean age was 78.8 /- 5.8 (66-83) years. All patients except one, who was treated by hemofiltration, were treated by hemodialysis. All patients except one, who had been treated with metildigoxin (0.35 mg/week), were also taking digoxin (0.375 mg/week). clarithromycin was administered at a dose of 200-400 mg/day for the treatment of bronchitis in all patients. The concomitant administration of clarithromycin increased serum digoxin levels from 1.8-4.0-fold in all cases. In two of six cases, a high probability of digoxin intoxication and suspicion of digoxin intoxication was evident. In three of six cases, serum digoxin levels increased within 12 days after the co-administration of clarithromycin, while in the other three cases, serum digoxin levels were increased 53-190 days after the administration of clarithromycin. CONCLUSION: The simultaneous administration of clarithromycin caused an increase in digoxin levels in six patients undergoing renal replacement therapy. The increase in the serum digoxin can be attributed to the inhibition of p-glycoprotein in the intestine and/or bile capillary rather than the kidney by clarithromycin since renal function was dramatically impaired, and four of the patients were anuric. The issue of why serum digoxin levels were increased so late in three patients undergoing renal replacement is unclear. However, this interaction seemed to be clinically significant even in ESRD patients, whose renal function was highly impaired. The simultaneous use of digoxin and clarithromycin should be avoided even in patients undergoing renal replacement therapy whose renal function is impaired, since digoxin levels may increase unexpectedly.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
8/33. Encephalopathy and peripheral neuropathy following diethylene glycol ingestion.The authors report a 24-year-old man who developed encephalopathy and rapid quadriplegia following ingestion of a solution containing diethylene glycol (DEG). As quadriparesis evolved, motor response amplitudes were markedly reduced with preserved conduction velocities. Studies during clinical recovery revealed marked motor conduction velocity slowing and prolonged distal latencies. These data indicate that DEG intoxication may cause a primary acute axonal sensorimotor polyneuropathy with demyelinating physiology during recovery.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
9/33. Chronic renal disease patients with severe star fruit poisoning: hemoperfusion may be an effective alternative therapy.We report a case of star fruit intoxication in a 60-yr-old male patient with a past medical history of diabetes mellitus and chronic renal failure. Clinical effects included hiccups, hearing impairment, urine retention, and disturbed consciousness. Star fruit intoxication was also the suspected cause of hypothermia, an unusual symptom. The patient remained comatose after receiving two sessions of hemodialysis. However, after a 6 h session of charcoal hemoperfusion following the second hemodialysis treatment, his consciousness returned to normal within 1 day. While no previous study on hemoperfusion therapy in star fruit intoxication has been reported, in view of the fatal outcome of star fruit intoxication in uremic patients, hemoperfusion may be an alternative therapy if intensified hemodialysis fails.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
10/33. status epilepticus induced by star fruit intoxication in patients with chronic renal disease.Star fruit has been reported as containing neurotoxins that often cause severe neurological complications in patients with chronic renal disease. We report two patients with chronic renal failure at a pre-dialyzed stage who developed refractory status epilepticus after ingestion of star fruit. In addition, we review 51 cases in the literature. Among 53 patients, 16 patients presented with epileptic seizures (30%). The mortality rate was as high as 75% in patients with seizures. On the other hand, in patients without seizures, the mortality rate was only 0.03%. There is a poor correlation with the degree of underlying renal function and mortality due to intoxication. We propose that epileptic seizure is significantly associated with poor prognosis, and that status epilepticus is an unpredictable and potentially fatal complication in star fruit intoxication. We advise consultant neurologists that star fruit intoxication must be considered when patients with chronic renal disease present with seizures or other unexplained neurological or psychiatric symptoms. Since no effective treatment has been established, star fruit consumption should be avoided in patients with chronic renal disease, especially in the elderly.- - - - - - - - - - ranking = 3.5keywords = intoxication (Clic here for more details about this article) |
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