1/3. 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 = 1keywords = intoxication (Clic here for more details about this article) |
2/3. Pronounced metabolic response to modest theophylline overdose.OBJECTIVE: To describe a patient who developed significant metabolic abnormalities in response to a low-level theophylline ingestion. CASE SUMMARY: An 18-year-old man was examined after ingesting theophylline 3 g in a suicide attempt. Although his peak theophylline concentration was 157 mumol/L (28.2 micrograms/mL), it was associated with significant leukocytosis, hypokalemia, hypomagnesemia, hypophosphatemia, hyperglycemia, and lactic acidosis. These abnormalities have been previously associated with theophylline intoxication, but only in conjunction with much higher peak concentrations of theophylline. CONCLUSIONS: Significant metabolic abnormalities can occur with suicidal ingestion of relatively small amounts of theophylline. The presence of these abnormalities should be sought in theophylline overdoses. In the proper clinical circumstances, such abnormalities should raise suspicion of covert theophylline ingestion.- - - - - - - - - - ranking = 0.125keywords = intoxication (Clic here for more details about this article) |
3/3. Carbon monoxide intoxication: a review of 14 patients.In 14 cases of carbon monoxide poisoning, medical records were available for retrospective review in which blood samples for carboxyhemoglobin (COHgb) were obtained. Twelve victims (86%) were overcome while at work. Correlation of the clinical picture and COHgb saturation was not always possible although hypertension was not uncommon initially. On follow-up only three patients were mildly hypertensive. skin or mucous membrane color changes were difficult to detect. Three cases are presented to illustrate factors in the diagnosis and possible sequelae.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |