1/8. hydrofluoric acid-induced burns and life-threatening systemic poisoning--favorable outcome after hemodialysis.BACKGROUND: skin contact with hydrofluoric acid (HF) may cause serious burns and life-threatening systemic poisoning. The use of hemodialysis in fluoride intoxication after severe dermal exposure to HF has been recommended but not reported. CASE REPORT: A 46-year-old previously healthy man had 7% of his body surface exposed to 71% HE Despite prompt management, with subsequent normalization of the serum electrolytes, recurrent ventricular fibrillation occurred. On clinical suspicion of fluoride-induced cardiotoxicity, acute hemodialysis was performed. The circulatory status stabilized and the patient fully recovered. High fluoride levels in the urine and serum were confirmed by the laboratory. DISCUSSION: There is no ultimate proof that the favorable outcome in this case was significantly attributable to the dialysis. However, most reported exposures of this magnitude have resulted in fatal poisoning. As our patient had normal serum electrolytes and no hypoxia or acidosis at the time of his arrhythmias, it was decided that all efforts should be focused on removing fluoride from his blood. The rationale for performing hemodialysis for this purpose is clear, even though such intervention is more obviously indicated in patients with renal failure. CONCLUSION: Hemodialysis may be an effective and potentially lifesaving additional treatment for severe exposure to HF when standard management has proven insufficient.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/8. hemoperfusion in a child with amitriptyline intoxication.Tricyclic antidepressant overdose is one of the most common causes of serious drug poisoning in children and adults. We report a 17-month-old girl with severe amitriptyline intoxication. She was admitted to hospital because of lethargy and seizures. It was estimated that she took approximately 75 mg/kg of amitriptyline 2 h before admission. On examination she was comatose, had ventricular tachycardia and multifocal clonic seizures. Intravenous fluid, per oral activated charcoal, diazepam, lidocaine, and sodium bicarbonate infusion were given. However, there was no response to this therapy, and the patient remained in a deep coma with cardiac arrhythmias and seizures. hemoperfusion (HP) was performed for 2 h. During this procedure, cardioversion was used six times due to ventricular fibrillation. She had a very good clinical response to HP and no complication was observed. We suggest that HP may be an effective treatment in children with severe amitriptyline intoxication.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
3/8. propranolol intoxication revealing a brugada syndrome.This is the first report of brugada syndrome revealed by beta-blocker intoxication. A 24-year-old healthy man ingested propranolol (2.28 g) to commit suicide. After early gastric lavage, electrolytes, cardiac enzymes, chest X-ray, and echocardiography were normal. Dosages of psychotropic drugs were negative. ECG showed a typical coved-type pattern of brugada syndrome. Follow-up showed partial ECG normalization of the discrete saddleback-type pattern. The ajmaline- test confirmed brugada syndrome. These ECG modifications may be explained by the stabilizing membrane effect of high concentration of propranolol and/or inhibition of ICaL. This case illustrates the possible deleterious effects of beta-blockers in patients with brugada syndrome.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
4/8. digitalis intoxication and treatment with digoxin antibody fragments in renal failure.Severe digitalis intoxication today is preferentially treated by intravenous infusion of Fab fragments of digoxin antibodies (digitalis Antidot BM). The kinetics of Fab fragments in the circulation are well known when kidney function is normal or slightly impaired. There are no data available, however, in complete renal failure. We observed a patient with life-threatening digitalis intoxication (serum digoxin, 3.7 ng/ml) and anuria, who was treated successfully by 160 mg Fab fragments i.v. serum digoxin and Fab fragment concentrations could be followed for 229 h. The extrarenal clearance of Fab fragments was lower (5.6 ml/min) than in patients with normal kidney function (10.9 ml/min). This finding suggests that lower doses than usual might be sufficient for treating patients with severe digitalis intoxication and renal failure.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
5/8. Magnesium and cardiac arrhythmias.The effectiveness of magnesium therapy in intractable ventricular tachycardia and ventricular fibrillation was documented in patients not only with hypomagnesemia, but also in patients with normomagnesemia. It was also effective in ventricular tachycardia characterized by 'torsades de pointes' and in massive digoxin intoxication. Prospectively, parenteral magnesium therapy was also effective in controlling the ventricular rate in multifocal atrial tachycardia (8 patients) by reducing the number and the rate of ectopic atrial foci. Parenteral magnesium sulfate administration, 10-15 ml of 20% MgSO4 in 1 min and 500 ml of 2% MgSO4 in 5 h in patients without renal failure was found to be safe and effective. magnesium sulfate prevented hyperpotassemia in massive digoxin intoxication and tended to produce hypopotassemia in other patients necessitating concomitant use of potassium chloride.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
6/8. Asystole and ventricular fibrillation associated with cocaine intoxication.We discuss a patient with cocaine intoxication in whom the initial presentation was that of asystole and ventricular fibrillation. cocaine has a direct toxic action on the heart and also sensitizes cardiac tissue to the action of catecholamines. cocaine intoxication should be considered in any patient with unexplained cardiac arrest or ventricular arrhythmias.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
7/8. Atraumatic cardiac arrest in apparently healthy young women.Sudden non-traumatic death in young people (< 30 years old) has been discussed both in systematic studies and anecdotal reports. After presenting three remarkable cases, a global survey of the incidence with special reference to the Belgian CPCR database, ethiopathogenesis and prognosis of sudden non-traumatic death in this specific age group is given. The atherosclerotic coronary artery disease (CAD) related and especially the non-CAD related causes are extensively discussed as well as the role of intoxication and increasing drug and substance abuse. After conventional cardiopulmonary resuscitation with restoration of spontaneous circulation and a favourable neurological outcome, a thorough search for the underlying disease is mandatory. The involvement of drugs or other toxins has to be excluded in the first place. Apart from transoesophageal echocardiography and coronary angiography, electrophysiological testing, serological exams, myocardial biopsy and magnetic resonance imaging should be considered.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
8/8. Prognostic implications of hyperkalemia in toad toxin intoxication.The toad possesses several toxic substances. Toad toxin poisoning manifests itself primarily with digitalis-like, cardioactive effects which results in bradycardia, varying degrees of atrio-ventricular block, ventricular tachycardia, ventricular fibrillation and sudden death. We report a cluster poisoning in a family who became intoxicated after ingestion of cooked toad soup for a skin problem. The youngest one (15 months old) died of refractory bradydyarrhythmias soon after arriving at our hospital. A second child (20 months old), who survived, arrived in shock with hyperkalemia (potassium 7.3 mEq/ L) and varying degrees of atrio-ventricular block. She was successfully treated with atropine, lidocaine, and cardioversion, and had a transvenous temporary pacemaker implanted for 1 day. The third boy (16 years old) had hyperkalemia (potassium 6.3 mEq/L) and bradycardia. The remaining three adults had only mild symptoms of nausea, vomiting, watery diarrhea and a sensation of numbness over their oral mucosa. We found that the level of serum potassium had prognostic implications in toad intoxication. Determination of serum potassium level is readily available in almost every hospital and is therefore more convenient to measure than serum digoxin level. We conclude that if hyperkalemia develops, the treatment of toad intoxication must be more aggressive to prevent mortality.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |