1/6. Acute barium intoxication and hemodiafiltration.We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/6. carbamazepine toxicity following Oxybutynin and dantrolene administration: a case report.OBJECTIVE: To report a case of carbamazepine toxicity following the administration of Oxybutynin and dantrolene. STUDY DESIGN: A case report. SETTING: The Spinal rehabilitation Department, Loewenstein Hospital, Raanana, israel. methods: A patient with C6D tetraplegia who sustained intoxication because of drug interaction is presented. She had been treated by carbamazepine 1000 mg/day for neuropathic pain for 2 years without clinical or laboratory signs of toxicity. After administration of Oxybutynin concomitantly with an increase in the dose of dantrolene, she presented the clinical symptoms and laboratory finding of carbamazepine intoxication. Trying to adjust the treatment to the patient's requirements, carbamazepine together with Oxybutynin and dantrolene was readministrated in lower doses. RESULTS: The combination of these drugs, even small doses, caused toxicity. Adding dantrolene and Oxybutynin elevated the blood level of carbamazepine, possibly by inhibition of cytochrome P450. CONCLUSION: A possible pharmacokinetic interaction between dantrolene and Oxybutynin should be borne in mind when considering carbamazepine medication for a patient with a spinal cord lesion.- - - - - - - - - - ranking = 0.4keywords = intoxication (Clic here for more details about this article) |
3/6. 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 = 0.2keywords = intoxication (Clic here for more details about this article) |
4/6. Development of a subacute tetraparesis after disulfiram intoxication. Case report.A chronic alcoholic was intoxicated with the excessive dose of 25 g of disulfiram and developed a subacute flaccid tetraparesis and an associated encephalopathy. The severity of the clinical picture is partly explained by malnourishment including folate and vitamin B12 deficiency. The clinical, electrophysiological and pathological examinations are in accordance with the concept of a central-peripheral distal axonopathy.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
5/6. Unusual foreign body causing quadriparesis: case report.OBJECTIVE AND IMPORTANCE: An unusual foreign body traversing the spinal canal at the foramen magnum level is described. Interesting radiological findings and a review of nonmissile penetrating injuries are presented. This case demonstrates the importance of a thorough physical examination and the use of neurodiagnostic imaging in an inebriated, uncooperative patient with neurological dysfunction. CLINICAL PRESENTATION: The patient presented with quadriparesis confounded by cocaine intoxication. A physical examination revealed only a small punctate lesion in the posterior occipital region. INTERVENTION: After detection of the foreign body, the patient underwent immediate surgical exploration and removal of the object. The dura was repaired primarily, and the patient was maintained on intravenous antibiotics for 7 days. CONCLUSION: With physical therapy, the patient was walking with assistance at 2 weeks postsurgery. upper extremity strength, especially intrinsic hand movement, was most severely affected. At 10 months' follow-up, the patient's only deficits were mild intrinsic hand weakness and incoordination with fine finger movements. Immediate surgical exploration is indicated for patients with retained fragments and progressive neurological dysfunction.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
6/6. Fatal bilateral adrenal hemorrhage following acute toluene poisoning: a case report.CASE REPORT: A 19-year-old woman was admitted to the emergency center with the development of quadriparesis after prolonged inhalation of lacquer thinner (67% toluene). Laboratory findings were compatible with a distal renal tubular acidosis manifest as metabolic acidosis, hypokalemia, and hyperchloremia. Despite potassium replacement, her condition deteriorated drastically 30 hours later. blood pressure became refractory to vasopressors, temperature was persistently above 40 degrees C, and death occurred 56 hours later. At autopsy, adrenal insufficiency secondary to bilateral adrenal hemorrhage was diagnosed. Bilateral adrenal hemorrhage should be considered as a potential cause of sudden clinical deterioration during treatment of serious toluene intoxication.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |