RESUMEN
INTRODUCTION: The widespread availability of medications and herbal products on the Internet has increased the potential for poisonings. We are reporting a case of mild, acute lithium toxicity occurring after the intentional misuse of a lithium-containing "dietary supplement" (Find Serenity Now) obtained over the Internet. CASE REPORT: An 18-year-old woman presented to our emergency department (ED) after ingesting 18 tablets of Find Serenity Now; each tablet contained, according to the listing, 120 mg of lithium orotate [3.83 mg of elemental lithium per 100 mg of (organic) lithium orotate compared to 18.8 mg of elemental lithium per 100 mg of (inorganic) lithium carbonate]. The patient complained of nausea and reported one episode of emesis. Her examination revealed normal vital signs. The only finding was a mild tremor without rigidity. Almost 90 minutes after the ingestion, her serum lithium level was 0.31 mEq/L, a urine drug screen was negative, and an electrocardiogram (ECG) showed a normal sinus rhythm. The patient received intravenous fluids and an anti-emetic; one hour later, her repeat serum lithium level was 0.40 mEq/L. After 3 hours of observation, nausea and tremor were resolved, and she was subsequently transferred to a psychiatric hospital for further care. Prior human and animal data have shown similar pharmacokinetics and shared clinical effects of these lithium salts. DISCUSSION: Over-the-Internet dietary supplements may contain ingredients capable of causing toxicity in overdose. Chronic lithium toxicity from ingestion of this product is also of theoretical concern.
Asunto(s)
Suplementos Dietéticos/envenenamiento , Compuestos de Litio/envenenamiento , Compuestos Organometálicos/envenenamiento , Adolescente , Femenino , Humanos , InternetRESUMEN
The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.
Asunto(s)
Carbunco/diagnóstico , Bacillus anthracis/aislamiento & purificación , Bioterrorismo , Enfermedades del Mediastino/diagnóstico por imagen , Infecciones del Sistema Respiratorio/microbiología , Esporas Bacterianas/aislamiento & purificación , Carbunco/sangre , Carbunco/terapia , Antibacterianos/uso terapéutico , Sangre/microbiología , Ciprofloxacina/uso terapéutico , Clindamicina/uso terapéutico , District of Columbia , Disnea/complicaciones , Fiebre/complicaciones , Humanos , Enfermedades Linfáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Exposición Profesional , Derrame Pleural/diagnóstico por imagen , Reacción en Cadena de la Polimerasa , Servicios Postales , Radiografía Torácica , Infecciones del Sistema Respiratorio/sangre , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/terapia , Rifampin/uso terapéutico , Sobrevivientes , Tomografía Computarizada por Rayos XRESUMEN
Superior sagittal sinus thrombosis (SSST) is an unusual disorder, most often attributed to hematological abnormalities, oral contraceptive use, or association with the puerperium. Although SSST secondary to trauma has been reported, it still remains an extremely rare entity. Antemortem diagnosis of SSST is made by findings on computed tomographic scanning, cerebral angiography, or magnetic resonance imaging. Prognosis is variable and spontaneous resolution has been reported. Successful treatment options of spontaneous cases include systemic anticoagulation and thrombolytic therapy along with supportive measures. There are currently no guidelines for the management of SSST associated with traumatic brain injury. This report describes a case of SSST in a man who sustained a closed head injury.
Asunto(s)
Traumatismos Craneocerebrales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/etiología , Adulto , Anticoagulantes/uso terapéutico , Angiografía Cerebral , Fibrinolíticos/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Pronóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To define the relationship between order of injection and pain of infiltration of buffered lidocaine. METHODS: Volunteers > or = 18 years of age were enrolled in a prospective, double-blind experimental protocol. Subjects received a 0.5-mL intradermal injection of anesthetic in each forearm. All injections were given by the same individual in the same manner. Immediately following each injection, the subjects rated the pain of infiltration on a standardized 100-mm visual analog pain scale. Both the subjects and the individual giving the injections were blinded to the anesthetic being administered. They were told that the injections could be either plain or buffered lidocaine. They were further informed that any individual subject could receive 2 of the same anesthetics or 1 of each in either order. In reality, all injections were buffered lidocaine for all subjects. Pain scores were converted to a numerical score by making measurements to the nearest millimeter and analyzed by a Wilcoxon signed-rank test with p < 0.05 considered significant. RESULTS: Fifty subjects were enrolled. The first injection had a median pain score of 13.5 mm, compared with 23.5 mm for the second (p = 0.007). CONCLUSION: The second injection of buffered lidocaine was found to be statistically more painful than the first in this protocol that controlled for all variables except for order of injection. Future studies involving paired comparisons should take this information into account.