RESUMEN
In acute poisoning with beta-blocking drugs and calcium-channel blockers patients may present with serious symptoms. We present a case of life-threatening sotalol and verapamil intoxication in a 29-year-old female suffering from depression. She was admitted to our hospital a few hours after she had taken 3.6 g verapamil and 4.8 g sotalol. On being found the patient was breathing and had a palpable pulse. On admission the patient experienced a cardiovascular collapse and CPR was started. Echocardiography confirmed cardiac standstill. After 4 h of normothermic CPR, extra corporeal heart lung assist (ECHLA) was established. Vasoactive drugs could be stopped after 2 days with ECHLA, and after 5 days the patient was extubated. The patient experienced several complications (intestinal bleeding, transient nerve paralysis, and renal failure due to rhabdomyolysis) but made a complete recovery and started working 6 months after the poisoning. She was no longer depressed.
Asunto(s)
Antagonistas Adrenérgicos beta/envenenamiento , Bloqueadores de los Canales de Calcio/envenenamiento , Reanimación Cardiopulmonar , Corazón Auxiliar , Sotalol/envenenamiento , Verapamilo/envenenamiento , Adulto , Femenino , Paro Cardíaco/inducido químicamente , Paro Cardíaco/terapia , Humanos , Respiración Artificial , Intento de SuicidioAsunto(s)
Anafilaxia/tratamiento farmacológico , Agonistas Adrenérgicos/administración & dosificación , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/inmunología , Anticonvulsivantes/administración & dosificación , Reanimación Cardiopulmonar , Epinefrina/administración & dosificación , Antagonistas de los Receptores Histamínicos/administración & dosificación , Humanos , Hidrocortisona/administración & dosificación , Mastocitos/inmunología , Guías de Práctica Clínica como AsuntoAsunto(s)
Agonistas Adrenérgicos/administración & dosificación , Broncodilatadores/administración & dosificación , Crup/tratamiento farmacológico , Epinefrina/administración & dosificación , Racepinefrina , Agonistas Adrenérgicos/química , Broncodilatadores/química , Niño , Epinefrina/química , Humanos , IsomerismoAsunto(s)
Acetaminofén , Analgésicos no Narcóticos , Acetaminofén/administración & dosificación , Acetaminofén/efectos adversos , Acetaminofén/metabolismo , Acetaminofén/farmacocinética , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Analgésicos no Narcóticos/metabolismo , Analgésicos no Narcóticos/farmacocinética , Disponibilidad Biológica , Niño , Humanos , Recién Nacido , Absorción IntestinalAsunto(s)
Servicios de Información sobre Medicamentos , Educación en Salud , Educación del Paciente como Asunto , Viaje , Infecciones Bacterianas/prevención & control , Mordeduras y Picaduras/tratamiento farmacológico , Humanos , Internet , Síndrome Jet Lag/prevención & control , Quemadura Solar/prevención & control , Vacunación , Virosis/prevención & controlAsunto(s)
Analgésicos Opioides/farmacología , Meperidina/análogos & derivados , Meperidina/farmacología , Morfina/farmacología , Dolor/tratamiento farmacológico , Enfermedad Aguda , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacocinética , Interacciones Farmacológicas , Humanos , Meperidina/efectos adversos , Meperidina/farmacocinética , Morfina/efectos adversos , Morfina/farmacocinéticaRESUMEN
MEGX (monoethylglycinexylidide) is the main metabolite of lidocaine and is 83 percent as potent as an antiarrhythmic drug and with the same toxicity as lidocaine. In this study, plasma levels of MEGX were measured in 10 other wise healthy women during and after breast augmentation. A total dose of 825 to 1,280 mg of lidocaine of 0.2% and 0.5% lidocaine with epinephrine corresponding to 16.3 to 21.8 mg/kg (mean, 18.2 mg/kg) was injected in the spatium between the pectoralis muscle and the mammary gland. The peak plasma concentrations of MEGX varied between 0.40 and 0.99 microg/ml (mean, 0.49 microg/ml) and occurred between 8 and 12 hours (mean, 9.1 hours), postoperatively. In three patients, the concentration of MEGX was still increasing after 12 hours. In comparison, the peak plasma concentrations of lidocaine varied between 0.96 and 3.12 microg/ml (mean, 1.49 microg/ml) and occurred between 4 and 12 hours (mean, 7.3 hours) after the end of the injection. The peak lidocaine + MEGX concentrations varied between 1.45 and 3.58 microg/ml (mean, 2.02 microg/ml) and occurred between 5 and 12 hours (mean, 8.5 hours), postoperatively. These data suggest that MEGX might contribute to lidocaine toxicity when high doses of lidocaine are injected. The substantial interindividual variation strongly indicates that recommendations about maximum safe doses of lidocaine should be made with caution.
Asunto(s)
Lidocaína/análogos & derivados , Mamoplastia , Femenino , Humanos , Lidocaína/sangre , Lidocaína/toxicidad , Factores de TiempoRESUMEN
OBJECTIVES: The aim of this study was to compare the rate of absorption between ordinary paracetamol tablets and effervescent paracetamol tablets. METHODS: Twenty healthy volunteers participated in an open randomised crossover study and were given a 1000-mg dose of either ordinary paracetamol tablets (2 x 500 mg Panodil tablets, SmithKline Beecham) or effervescent paracetamol tablets (2 x 500 mg Pinex Brusetablett, Alpharma AS) with a 3-week washout period in between. Blood samples were collected for 3 h. Maximum serum concentration (Cmax) and the time to maximum serum concentration (tmax) were recorded and the area under the concentration versus time curve (AUC) was calculated. RESULTS: The mean tmax was significantly shorter when paracetamol effervescent tablets were taken (27 min) rather than ordinary paracetamol tablets (45 min) (P = 0.004). There was no significant difference between the mean Cmax of 143 micromol/l with effervescent tablets and that of 131 micromol/l with ordinary tablets. The mean AUC(0-3 h) was significantly higher with paracetamol effervescent tablets (223.8 micromol x h x l(-1)) than with ordinary tablets (198.2 micromol x h x l(-1); P = 0.003). After 15 min, 17 (85%) subjects in the effervescent group had a serum concentration of 70 micromol/l (lower therapeutic serum concentration) or higher relative to only 2 (10%) subjects in the ordinary tablet group (P = 0.001). CONCLUSION: Paracetamol effervescent tablets are absorbed significantly faster than ordinary paracetamol. Thus, effervescent tablets might offer significantly faster pain relief when paracetamol is used.
Asunto(s)
Acetaminofén/administración & dosificación , Acetaminofén/farmacocinética , Acetaminofén/sangre , Administración Oral , Adulto , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Comprimidos/metabolismo , Factores de TiempoRESUMEN
BACKGROUND: Epidural infusion of morphine, usually with bupivacaine, for postoperative pain relief has proved to be safe and effective. Lidocaine with its short duration of action and low toxicity may be an alternative to bupivacaine. The clinical importance of the choice of local anaesthetic drug on mobilisation after lower abdominal surgery has not been studied previously. METHODS: A total of 52 patients was randomised to epidural infusion of morphine (1.6-4.4 micrograms.kg-1.h-1) with either lidocaine (0.44-0.98 mg.kg-1.h-1) or bupivacaine (0.10-0.28 mg.kg-1.h-1) in a double-blind fashion. The time to mobilisation, degree of pain relief, blood pressure, respiration and motor function were recorded at regular intervals postoperatively for 40 h. Serum concentrations of lidocaine, its main metabolite monoethylglycinexylidide (MEGX) and bupivacaine were measured at 3, 15 and 40 h. RESULTS: There were no significant differences in the clinical characteristics between the two patient groups. There were no significant differences in the time from the end of surgery to the time the patients were able to stand without support (bupivacaine: median 24 h (interquartile range (IQR): 22-31), lidocaine: median 28 h (IQR 23-40), P = 0.15) or were able to walk without support (bupivacaine: median 46 h (IQR 28-62), lidocaine: median 48 h (IQR 35-54), P = 0.78). No significant differences between the groups were recorded with respect to pain relief, blood pressure, respiration, sedation score and motor function. The plasma concentration of lidocaine and bupivacaine increased significantly during the treatment period (P < 0.01 for both drugs), but not the concentration of MEGX. The highest venous lidocaine concentration was 17.5 mumol/l and the highest bupivacaine concentration was 18.8 mumol/l. There was a significant correlation between the concentration of both lidocaine and bupivacaine and the concentration of alpha 1-acid glycoprotein (AAG) (lidocaine: r = 0.77, P < 0.001, bupivacaine: r = 0.60, P < 0.001), suggesting that the free fraction of the drugs did not increase. No patients showed serious signs of toxicity. The epidural infusion rates remained stable in both groups during the study period. CONCLUSION: There were no clinically or statistically significant differences in the postoperative course after lower abdominal surgery in patients who received an epidural infusion of morphine combined with bupivacaine as compared to patients who received morphine with lidocaine. Further clinical studies to establish the place of lidocaine in postoperative epidural analgesia should be performed.
Asunto(s)
Abdomen/cirugía , Analgesia Epidural/métodos , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Lidocaína/uso terapéutico , Locomoción/fisiología , Morfina/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Anciano , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/sangre , Anestésicos Locales/administración & dosificación , Anestésicos Locales/sangre , Presión Sanguínea/efectos de los fármacos , Bupivacaína/administración & dosificación , Bupivacaína/sangre , Estado de Conciencia/efectos de los fármacos , Método Doble Ciego , Femenino , Estudios de Seguimiento , Glicoproteínas/sangre , Humanos , Lidocaína/administración & dosificación , Lidocaína/análogos & derivados , Lidocaína/sangre , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/sangre , Músculo Esquelético/efectos de los fármacos , Respiración/efectos de los fármacosRESUMEN
Plasma levels of lidocaine and the main binding proteins of lidocaine in plasma alpha1-acid glycoprotein (AAG) and albumin were measured in 10 otherwise healthy women during and after breast augmentation. A total dose of 825 to 1280 mg of 0.2% and 0.5% lidocaine with epinephrine corresponding to 16.3 to 21.8 mg/kg (mean 18.2 mg/kg) was injected in the spatium between the pectoralis muscle and the mammary gland. The peak plasma concentrations of lidocaine varied between 0.96 and 3.12 microg/ml (mean 1.49 microg/ml) and occurred between 4 and 12 hours (mean 7.3 hours) postoperatively. The plasma concentration of AAG varied between 0.42 and 1.73 g/liter (mean 0.49 g/liter, normal range 0.54 to 1.17 g/liter). There was a significant correlation between the plasma concentration of AAG and lidocaine. The mean concentration of albumin was 37.2 g/liter, ranging from 33 to 42 g/liter (normal range 35 to 50 g/liter). No patient showed signs of lidocaine toxicity. These data indicate that a dose of 20 mg/kg of lidocaine with epinephrine probably is safe in breast augmentation when the drug is administrated as described in this study. There are significant individual differences in the plasma concentration curves between patients, partly explained by different concentrations of AAG. Further studies with a larger number of patients are needed to establish definitive recommendations of safe maximal doses.
Asunto(s)
Anestésicos Locales/sangre , Implantación de Mama , Lidocaína/sangre , Orosomucoide/metabolismo , Absorción , Adulto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacocinética , Femenino , Humanos , Lidocaína/administración & dosificación , Lidocaína/farmacocinética , Análisis de Regresión , Albúmina Sérica/metabolismoRESUMEN
Nutmeg is an easily obtainable spice that has been widely used domestically for centuries because of its psychotropic effects. Several cases of nutmeg poisoning, including one fatality, have been published. The active ingredients are volatile oils where myristicin and elemicin are thought to be the most important constituents. These have anticholinergic and psychotropic properties and are metabolised to compounds similar to amphetamine. We present the first reported case of nutmeg poisoning in Norway.
Asunto(s)
Psicotrópicos/envenenamiento , Especias/envenenamiento , Adulto , Humanos , Masculino , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/etiologíaRESUMEN
A follow-up study of mortality and factors associated with death from various causes were done on two unselected groups of patients surviving deliberate self-poisoning in 1978 and 1987. The persons were studied up to the end of 1993. In 1978 the group included 152 female and 101 male subjects and in 1987 the group included 190 female and 144 male subjects. By the end of 1993 a total of 37 (24%) of the female and 33 (33%) of the male patients admitted in 1978 had died (n.s.) and 18 (10%) of the female and 29 (20%) of the male patients admitted in 1987 had died (P < 0.01). The main causes of death were suicide and death from cardiovascular disease. The 5-year follow-up mortality more than doubled in males from 1978 to 1987 but decreased in females. In female subjects, the total follow-up mortality was 3.6 times the expected ratio, with a 95% confidence interval (95% CI of 2.7-4.6); in male subjects it was 5.0 times the expected ratio (95% CI = 3.8-6.4). The cause-specific mortality ratio was highest for deaths from suicide--in the female group it was 65.5 (39.4-102.3) times the expected and in the male group 41.5 (26.0-62.8)--and from accidental poisoning--for females 50.0 (6.1-180.6) times the expected and for males 66.7 (24.5-145.1). In the female group none of the variables examined reached significance as predictors for subsequent suicide or death from unnatural causes. In the male group being aged 30 years or more came out as a predictor for subsequent suicide [relative risk (RR) = 5.66 (1.05-30.37)], while imprisonment came out as a protective factor [RR = 0.08 (0.01-0.64)]. Significant predictors for death from unnatural causes were: having been convicted (but not been in jail) [RR = 34.01 (1.07-1078.15)] and a serious suicidal intent [RR = 138.62 (1.38-13,946.79)]. It is concluded that patients who survive deliberate self-poisoning are at increased risk of death. The predictors for death are not very specific and are considered difficult to apply in the clinical work with these patients.
Asunto(s)
Causas de Muerte , Sobredosis de Droga/mortalidad , Intento de Suicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Estudios Prospectivos , Recurrencia , Riesgo , Análisis de SupervivenciaRESUMEN
BACKGROUND: There was an obvious need to improve the quality and safety of our postoperative pain treatment and to introduce an improved routine service on surgical wards. METHODS: It was decided to use postoperative epidural infusion of morphine 0.04 mg/ml and bupivacaine 2.5 mg/ml (0.25%) 4-8 ml/h as pain relief after major surgery. An education programme was run emphasising the benefits, side-effects and the importance of regular monitoring of pain intensity, vital functions (respiratory rate, blood pressure, heart rate), motor function of the legs and the need for additional drugs in order to detect side-effects as well as lack of adequate analgesic effect. A detailed observation sheet was used collecting information every 2 h throughout the epidural treatment period in order to secure monitoring and adjustment of the treatment. Close contact was maintained with the wards. RESULTS: We present a detailed analysis of our first 2000 postoperative patients, mainly after orthopaedic (46.1%), gastrointestinal (32.0%), urologic (8.7%) and vascular (8.5%) surgery. Duration of the treatment was less than 24 h in 41.4% and more than 48 h in 29.7%. Pain relief was adequate in most patients, best after vascular surgery in the lower extremities (mean VAS 0.15/10.0 (95% confidence interval 0.09-0.23)) and less after gastrointestinal (mean VAS 0.49/10 (0.43-0.54)) and thoracic surgery (mean VAS 0.59/10 (0.38-0.81)). The infusion was stopped due to respiratory depression in 3 patients (0.15%). Four (0.2%) had systolic blood pressure < 80 mmHg and had to be treated with vasopressors. A total of 56 (2.8%) patients were considered to be problem patients due to excessive sedation (0.4%), hypotension (0.7%), respiratory depression (1.6%) or lower extremity paralysis (0.05%). All patients had urinary catheter until 6 h after termination of the epidural treatment. One patient had the epidural catheter accidentally placed subarachnoidally and experienced severe respiratory depression. No permanent sequelae were recorded in the postoperative patients, but 2 traumatised patients developed epidural abscesses after 3 weeks of treatment, which resulted in lower extremity paralysis. Late response to the warning signs might have contributed to the irreversible paraplegia. CONCLUSION: Our experience with this postoperative epidural analgesia regime is favourable. It has been easy to administer and monitor. Pain relief was excellent, side-effects were few and picked up by the established routines followed by the ward staff except in the 2 trauma patients who developed epidural abscesses. The staff on the surgical wards were motivated for this kind of work. Education and strict surveillance routines are mandatory in order to secure prompt action when warning signs develops (e.g. lower limb paralysis).
Asunto(s)
Analgesia Epidural , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Morfina/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Bupivacaína/efectos adversos , Femenino , Estudios de Seguimiento , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Morfina/efectos adversos , Respiración/efectos de los fármacosRESUMEN
The 15-year follow-up of mortality and the factors associated with death from various causes were studied in an unselected group of patients surviving deliberate self-poisoning in 1978. The cohort included 152 females and 101 males. By the end of 1993 a total of 37 (24%) of the females and 33 (33%) of the males admitted in 1978 had died. The total follow-up mortality was 4.5 times greater than expected for the female group (95% confidence interval: 3.1-6.1) and 3.6 times greater than expected (2.5-5.1) for the male group. It was highest in the first 5-year period. With regard to specific causes the mortality ratio was highest for deaths from suicide. For females it was 61.1 (30.5-109.4) and for males: 38.8 (20.4-65.4) times the expected ratio. It was also significantly raised for deaths from cardiovascular diseases in females: SMR = 3.7 (2.0-6.4) and from respiratory diseases in males: SMR = 3.3 (1.2-7.1). Significant predictors for death from all causes were age > or = 30 years: RR = 4.4 (2.3-8.5) and male sex: RR = 2.1 (1.2-3.5). Imprisonment was found to be a protective factor: RR = 0.2 (0.1-0.5). Predictors for death from suicide were age > or = 30: RR = 3.1 (1.2-8.1), male sex: RR = 3.3 (1.4-7.9) and a serious suicidal attempt, as evaluated by a psychiatrist: RR = 3.4 (1.4-7.9). It is concluded that patients who survive parasuicide by deliberate self-poisoning are at increased risk of death. The predictors for death are not very specific and are difficult to apply in clinical work with these patients.