RESUMEN
Acetaminophen and acetaminophen combination products are the most frequent medications involved in intentional and unintentional poisonings. The 2008 National Poison Data System compiled by the American Association of Poison Control Centers documented 98,578 acetaminophen-related poisonings, which includes 91 fatalities. Very few case reports of ingestions of acetaminophen extended release with anticholinergics are reported in the literature.
Asunto(s)
Acetaminofén/envenenamiento , Preparaciones de Acción Retardada/envenenamiento , Difenhidramina/envenenamiento , Sobredosis de Droga/epidemiología , Acetaminofén/farmacocinética , Adulto , Preparaciones de Acción Retardada/farmacocinética , Difenhidramina/farmacocinética , Femenino , Humanos , Centros de Control de Intoxicaciones/estadística & datos numéricos , Intento de Suicidio , Estados Unidos/epidemiologíaRESUMEN
Sustained-release calcium channel blocker (CCB SR) overdoses are potentially life-threatening ingestions. These patients may not become hemodynamically unstable until many hours after ingestion. On theoretical grounds, some have suggested that whole bowel irrigation (WBI) with polyethylene glycol electrolyte lavage solution may be of value in the management of these cases. We report two cases with poor outcome (including one fatality) that were complicated by the use of WBI. Both cases were treated with WBI beginning before and continuing after developing hypotension. WBI should be avoided in the setting of the hemodynamically unstable CCB SR overdose.
Asunto(s)
Actitud del Personal de Salud , Bloqueadores de los Canales de Calcio/envenenamiento , Intestinos/irrigación sanguínea , Irrigación Terapéutica/métodos , Sobredosis de Droga , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Intento de Suicidio/psicologíaAsunto(s)
Antídotos/uso terapéutico , Antituberculosos/envenenamiento , Isoniazida/envenenamiento , Piridoxina/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Adolescente , Adulto , Antídotos/economía , Antídotos/provisión & distribución , Femenino , Humanos , Illinois , Masculino , Centros de Control de Intoxicaciones/estadística & datos numéricos , Piridoxina/economía , Piridoxina/provisión & distribución , Estudios Retrospectivos , Resultado del Tratamiento , Complejo Vitamínico B/economía , Complejo Vitamínico B/provisión & distribuciónAsunto(s)
Antídotos/provisión & distribución , Inventarios de Hospitales/normas , Compuestos de Pralidoxima/provisión & distribución , Antídotos/uso terapéutico , Industria Farmacéutica , Almacenaje de Medicamentos , Guías como Asunto , Humanos , Insecticidas/envenenamiento , Compuestos Organofosforados , Servicio de Farmacia en Hospital/organización & administración , Servicio de Farmacia en Hospital/provisión & distribución , Compuestos de Pralidoxima/uso terapéutico , Estados UnidosAsunto(s)
Antídotos/administración & dosificación , Conservadores Farmacéuticos/efectos adversos , Piridoxina/administración & dosificación , Antídotos/economía , Relación Dosis-Respuesta a Droga , Humanos , Inyecciones Intravenosas , Isoniazida/envenenamiento , Intoxicación/tratamiento farmacológico , Conservadores Farmacéuticos/economía , Piridoxina/economíaRESUMEN
A 33-y-old male developed severe acidosis, renal failure, and profound neutrophilia after ingesting ethylene glycol. Workup for his neutrophilia excluded infectious and malignant causes. An elevated leukocyte alkaline phosphatase (LAP) level confirmed a leukemoid response, and the neutrophila resolved. Although several leukemoid reactions have been published due to therapeutic agents these reports are often incomplete or inaccurate; this is the first case of leukemoid response to a toxin. Leukemoid response is distinguishable from leukemia by the absence of clonally derived cells, although this is not easily apparent in extreme neutrophilia. Elevated LAP is useful in identifying leukemoid reaction from leukemia in cases of extreme neutrophila. If a patient develops extreme neutrophila in association with drug or toxin exposure, a leukemoid reaction should be considered and an LAP obtained.