1/23. Nephrotoxic acute renal failure in a renal transplant patient with recurrent lymphocele treated with povidone-iodine irrigation.povidone-iodine sclerosis has been suggested in the literature as a safe and effective treatment for post-renal transplant lymphoceles. No significant complications of this method have been described. We report on a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine instillations who developed acute renal failure secondary to iodine intoxication. Four days after the beginning of the povidone-iodine irrigations, metabolic acidosis was present, and renal function started to deteriorate. After a few days, despite the suspension of irrigations, the patient developed oliguria, and dialysis was needed. A renal biopsy was performed, and intense acute tubular necrosis was the only relevant finding. The lymphocele was corrected surgically, and the patient eventually recovered. As has been described in other settings, povidone-iodine instillation for the treatment of post-renal transplant lymphoceles may lead to iodine kidney toxicity and acute renal failure.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/23. Three cases of recurrent epileptic seizures caused by endosulfan.To commit suicide, three young adults swallowed a relatively small amount of a widely used insecticide containing endosulfan. They developed recurrent epileptic seizures. After hospitalization they were treated and recovered without any sequel. These seizures were classified as acute symptomatic or provoked seizures. We suggest that if one faces acute repetitive seizures, especially in the rural areas, an intoxication such as endosulfan intoxication should be considered when the etiology is uncertain even in the absence of any signs of intoxication.- - - - - - - - - - ranking = 3keywords = intoxication (Clic here for more details about this article) |
3/23. ondansetron to prevent emesis following N-acetylcysteine for acetaminophen intoxication.We present a 17-year-old girl who developed persistent vomiting following acetaminophen overdose. Because of the amount of drug ingested (300 mg/kg acetaminophen) and the four-hour postingestion level (256 micrograms/ml), administration of N-acetylcysteine (NAC) was indicated. Emesis occurred immediately following the first three doses of NAC despite administering the drug by continuous nasogastric drip over one hour. Prior to the next attempt, ondansetron (0.15 mg/kg) was administered intravenously as an antiemetic. Thirty minutes following ondansetron, NAC was tolerated without further emesis. Although several antiemetics may have prevented further emesis, we chose ondansetron since, as a serotonin antagonist, it does not cause extrapyramidal side effects or sedation. In patients with potentially toxic drug ingestions, these side effects may be confused with or mask the adverse effects of the ingested drug, thereby interfering with the ongoing evaluation of the patient. Although not previously administered for this indication, ondansetron has several advantages over other antiemetic agents in the setting of an acute drug ingestion.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
4/23. Recurrent severe anion gap metabolic acidosis secondary to episodic ethylene glycol intoxication.Acute ethylene glycol toxicity and its attendant metabolic derangement is a well described clinical entity. Recurrent severe anion gap metabolic acidosis consequent to episodic ingestion of ethylene glycol has not been previously reported. We present a patient who developed severe anion gap metabolic acidosis with no osmolar gap and hypokalemia, consequent to episodic ethylene glycol ingestion. Modest artifactual elevation of the serum lactic acid level and rapid response to intravenous bicarbonate infusion may serve as diagnostic clues. Consideration of these aberrant features should be included in the clinical assessment of severe anion gap metabolic acidosis.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
5/23. Methyl bromide intoxication causes reversible symmetric brainstem and cerebellar MRI lesions.Methyl bromide is toxic to the central and peripheral nervous systems. A patient with occupational exposure to this agent is described. MRI showed strikingly symmetric brainstem and cerebellar lesions. The patient's clinical course and the topography and resolution of his MRI abnormalities suggest that this condition is an energy deprivation syndrome.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
6/23. Hallucinogen persisting perception disorder after psilocybin consumption: a case study.The recurrence of flashbacks without acute or chronic hallucinogen consumption has been recognized in the DSM IV criteria as the hallucinogen persisting perception disorder (HPPD). Perceptual disturbances may last for 5 years or more and represent a real psychosocial distress. We reported here a case of a 18-year-old young man presenting HPPD after a mixed intoxication with psylocibin and cannabis. This report shows symptomatic recurrences persisting more than 8 months. Various differential diagnoses were evoked and our therapeutic strategies were described.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/23. dextromethorphan psychosis, dependence and physical withdrawal.As part of a synthesis of evidence regarding the abuse and addiction liability of dextromethorphan (DM), an over-the-counter cough medicine available in over 140 preparations, an uncommonly published case of dextromethorphan dependence (addiction) is described, with specific, rarely published complications. The individual was interviewed and several medical databases were also reviewed (medline, 1966-present; pubmed) for all content relating to the Keywords: dextromethorphan, abuse, dependence, cough medicine, addiction, withdrawal, psychosis. The patient evidenced history suggesting substance dependence, substance-induced psychosis and substance withdrawal in relation to DM. A literature review revealed that DM has specific serotonergic and sigma-1 opioidergic properties. dextrorphan (DOR), the active metabolite of DM, has similar properties; however, DOR is a weaker sigma opioid receptor agonist, and a stronger NMDA receptor antagonist. DM and DOR display specific biological features of addiction, and are capable of inducing specific psychiatric sequelae. A specific, reproducible toxidrome with significant psychiatric effects occurred, when DM was abused at greater than indicated doses, with more profound and potentially life-threatening effects at even higher doses. DM withdrawal appears evident. DM's active metabolite, DOR, has pharmacodynamic properties and intoxication effects similar to dissociatives, and may be more responsible for the dissociative effect that this DM abuser sought. However, it is this same metabolite that may be fraught with the potentially life-threatening psychoses and dissociative-induced accidents, as well as addiction. While DM has been hypothesized as the most commonly abused dissociative, health-care providers seem largely unaware of its toxidrome and addiction liability.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
8/23. Torsade de pointes and T-U wave alternans associated with arsenic poisoning.Arsenic intoxication is a common form of heavy metal poisoning. Although arsenic-induced circulatory collapse, seizures, and syncope are well known, the potential for serious ventricular arrhythmias is less well recognized. Reported in this study are two cases of arsenic poisoning causing torsade de pointes. Furthermore, marked prolongation of the QT-U interval and the rarely observed phenomenon of T-U wave alternans are demonstrated. Thus, arsenic intoxication may be complicated by prolongation of the QT-U interval and torsade de pointes. T-U wave alternans occurs in the presence of a long QT-U interval and may be an electrocardiographic warning sign of torsade de pointes.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
9/23. Recurrent classic migraine attacks following transdermal scopolamine intoxication.A 20 year old male naval crew-member suffering from sea sickness was treated with transdermal scopolamine (TS). After 5 months of continuous treatment, he developed scopolamine intoxication followed by the appearance of recurrent classic migraine attacks. He had never suffered from headache or migraine prior to TS intoxication. The migraine attacks comprised a prodrome of apathy, bad mood and loss of appetite lasting several hours. An aura of scintillating spots, left arm numbness and paresthesias lasting several minutes was followed by a severe throbbing unilateral headache with photophobia, sonophobia and nausea. After one year of repeated follow-up examination, he continued to suffer from the attacks once every 10 to 14 days, with no identified precipitating factors. We are not aware of similar cases in the medical literature. Although it is not possible to establish TS intoxication as a causal effect of the appearance of classic migraine in our patient, the temporal association and clinical course are very supportive of this assumption. central nervous system neurotransmitter imbalance of cardiovascular alterations may possibly be implicated.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
10/23. Recurrent pancreatitis secondary to hypercalcemia following vitamin d poisoning.A 66-year-old patient had been admitted four times for recurrent episodes of acute pancreatitis. At each time, elevated serum calcium levels, between 13.5-14.5 mg/dl, were found. Surgical drainage of necrotic pancreatic tissue had to be done on one occasion. Extensive investigations failed to disclose any conventional hypercalcemic disease. At his latest admission, the serum calcium level was 13.4 mg/dl, and the serum amylase level was 440 IU/L (N, less than 85). This time, the serum 25-OH vitamin d levels were investigated using radioimmunology and proved to be raised to 330 micrograms/L (normal, 16-74 micrograms/L). Specific questioning of the patient revealed that he had been taking regularly excessive quantities of vitamin supplements as a self medication. After stopping vitamin intake, his serum amylase levels returned to normal, and he had no more episodes of pancreatitis. This case illustrates vitamin d intoxication as a cause of recurrent pancreatitis. Measuring serum 25-OH vitamin d levels is advocated in pancreatitis associated with hypercalcemia of unclear origin.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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