Asunto(s)
Fármacos Antiobesidad/envenenamiento , Atropina/envenenamiento , Diazepam/envenenamiento , Emodina/análogos & derivados , Hipertensión/inducido químicamente , Fenilpropanolamina/envenenamiento , Taquicardia/inducido químicamente , Triyodotironina/envenenamiento , Adolescente , Carbón Orgánico/uso terapéutico , Combinación de Medicamentos , Sobredosis de Droga/complicaciones , Emodina/envenenamiento , Femenino , HumanosRESUMEN
OBJECTIVE: To evaluate signalment, clinical signs, dose ingested, treatment requirements, duration of hospitalization, and outcome of dogs exposed to phenylpropanolamine. DESIGN: Retrospective case series. ANIMALS: 170 dogs with potential PPA toxicosis evaluated between 2004 and 2009. PROCEDURES: Dogs with potential PPA toxicosis were identified by reviewing the electronic database of an animal poison control center. RESULTS: 66 of the 170 (39%) dogs reportedly did not develop any clinical signs. Clinical signs reported in the remaining 104 (61%) dogs included agitation (n = 40), vomiting (27), mydriasis (19), lethargy (17), tremor or twitching (16), panting (15), bradycardia (13), tachycardia (12), hypertension (11), and erythema (8). Median dose ingested for all dogs was 29 mg/kg (13.2 mg/lb). Dogs developing clinical signs had a significantly higher median dose ingested (373 mg/kg [170 mg/lb]) than did dogs that did not develop clinical signs (18 mg/kg [8.2 mg/lb]). Likewise, median dose ingested for the 123 dogs treated as inpatients (36.9 mg/kg [16.8 mg/lb]) was significantly higher than the median dose for the 14 dogs treated as outpatients (20.5 mg/kg [9.3 mg/lb]). Median duration of hospitalization was 18 hours (range, 4 to 72 hours), and hospitalization time increased as the dose ingested increased. Survival rate was 99.4% (169/170); the dog that died had ingested a dose of 145 mg/kg (65.9 mg/lb). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that with supportive care, the prognosis for dogs that had ingested an overdose of phenylpropanolamine was excellent.
Asunto(s)
Enfermedades de los Perros/inducido químicamente , Enfermedades de los Perros/mortalidad , Fenilpropanolamina/envenenamiento , Simpatomiméticos/envenenamiento , Animales , Perros , Relación Dosis-Respuesta a Droga , Femenino , Tiempo de Internación , Masculino , Centros de Control de Intoxicaciones/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Although the multi-component weight loss supplement Redotex is banned in the United States, the supplement can be obtained in Mexico. The intent of this report was to describe the pattern of Redotex calls received by a statewide poison center system. Cases were all Redotex calls received by Texas poison centers during 2000-2008. The distribution of total calls and those involving ingestion of the supplement were determined for selected demographic and clinical factors. Of 34 total Redotex calls received, 55.9% came from the 14 Texas counties that border Mexico. Of the 22 reported Redotex ingestions, 77.3% of the patients were female and 45.5% 20 years or more. Of the 17 ingestions involving no co-ingestants, 52.9% were already at or en route to a health care facility, 41.2% were managed on site, and 5.9% was referred to a health care facility. The final medical outcome was no effect in 23.5% cases, minor effect in 5.9%, moderate effect in 11.8%, not followed but minimal clinical effects possible in 47.1%, and unable to follow but judged to be potentially toxic in 11.8%. Most Redotex calls to the Texas poison center system originated from counties bordering Mexico.
Asunto(s)
Fármacos Antiobesidad/envenenamiento , Atropina/envenenamiento , Diazepam/envenenamiento , Suplementos Dietéticos/envenenamiento , Emodina/análogos & derivados , Fenilpropanolamina/envenenamiento , Centros de Control de Intoxicaciones/estadística & datos numéricos , Triyodotironina/envenenamiento , Distribución por Edad , Combinación de Medicamentos , Emodina/envenenamiento , Femenino , Humanos , Masculino , Intoxicación/epidemiología , Estudios Retrospectivos , Factores Sexuales , Texas/epidemiología , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Coricidin HBP, a cold medication containing dextromethorphan, has become a popular agent abused among adolescents. This retrospective chart review examines the potential psychiatric manifestations of Coricidin HBP misuse and patterns of use among patients treated in an inpatient child and adolescent psychiatric unit. Coricidin HBP use was documented in 47 patient. The data revealed that Coricidin HBP use was associated with: (a) predominantly depressive symptomatology; (b) transient substance-induced psychosis; (c) cardiac toxicity; and (d) greater quantities used per episode by Caucasians. Clinicians treating adolescents need to be aware of the abuse potential and psychiatric manifestations of this dextromethorphan-containing product.
Asunto(s)
Acetaminofén/envenenamiento , Clorfeniramina/envenenamiento , Trastorno Depresivo/inducido químicamente , Trastorno Depresivo/epidemiología , Dextrometorfano/envenenamiento , Sobredosis de Droga/epidemiología , Bloqueo Cardíaco/inducido químicamente , Hospitalización , Fenilpropanolamina/envenenamiento , Psicosis Inducidas por Sustancias/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Taquicardia Ventricular/inducido químicamente , Adolescente , Factores de Edad , Alcoholismo/epidemiología , California , Niño , Comorbilidad , Estudios Transversales , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Femenino , Bloqueo Cardíaco/epidemiología , Humanos , Masculino , Trastornos Mentales/epidemiología , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Taquicardia Ventricular/epidemiologíaRESUMEN
PURPOSE OF REVIEW: Over-the-counter cough and cold medicines are widely prescribed by general pediatricians in order to relieve cough and other symptoms in the setting of upper respiratory infections. This article will review the pharmacologic components found in over-the-counter cough medicines, the data concerning their use and efficacy in children, the increasing trend of abuse of these medications, and their potential toxicity. RECENT FINDINGS: There is an overall paucity of data evaluating the use of over-the-counter cough medicines in children as well as a lack of evidence for their efficacy. The articles cited will review the efficacy of over-the-counter cough medicines, the emerging trend of abuse of certain preparations such as dextromethorphan, and specific cases of morbidity and even mortality. SUMMARY: According to the limited data that exist, there is not any evidence that over-the-counter cough and cold medicines are effective in children. In otherwise healthy children without chronic complicating factors such as asthma, the symptoms of acute upper respiratory infections are generally mild and self-limited. Pediatricians must weigh the benefits against the potential risks of recommending over-the-counter cough medicines and should be prepared to educate parents about the expected natural course of their child's illness and the likelihood that these medications will be minimally effective in relieving symptoms, if at all.
Asunto(s)
Medicamentos sin Prescripción/uso terapéutico , Antitusígenos/efectos adversos , Antitusígenos/uso terapéutico , Niño , Dextrometorfano/efectos adversos , Dextrometorfano/uso terapéutico , Sobredosis de Droga , Humanos , Lactante , Descongestionantes Nasales/uso terapéutico , Medicamentos sin Prescripción/efectos adversos , Medicamentos sin Prescripción/envenenamiento , Fenilpropanolamina/envenenamientoAsunto(s)
Dextrometorfano/envenenamiento , Acetaminofén/envenenamiento , Adolescente , Clorfeniramina/envenenamiento , Delirio/inducido químicamente , Combinación de Medicamentos , Sobredosis de Droga/diagnóstico , Femenino , Alucinaciones/inducido químicamente , Humanos , Nistagmo Patológico/inducido químicamente , Fenilpropanolamina/envenenamientoRESUMEN
Drug abuse affects a significant number of individuals of all ages. Health care practitioners must be knowledgeable about both the physiological effects of such drugs and the impact of drug-seeking behavior on their patients.
Asunto(s)
2,5-Dimetoxi-4-Metilanfetamina/análogos & derivados , Drogas de Diseño/envenenamiento , Drogas Ilícitas/envenenamiento , Trastornos Relacionados con Sustancias/etiología , 2,5-Dimetoxi-4-Metilanfetamina/envenenamiento , 4-Butirolactona/envenenamiento , Catha/envenenamiento , Drogas de Diseño/provisión & distribución , Dibenzotiazepinas/envenenamiento , Diterpenos/envenenamiento , Diterpenos de Tipo Clerodano , Control de Medicamentos y Narcóticos , Flunitrazepam/envenenamiento , Alucinógenos/envenenamiento , Humanos , Drogas Ilícitas/provisión & distribución , Ketamina/envenenamiento , Dietilamida del Ácido Lisérgico/envenenamiento , Metanfetamina/envenenamiento , Motivación , N-Metil-3,4-metilenodioxianfetamina/envenenamiento , Fenciclidina/envenenamiento , Fenilpropanolamina/envenenamiento , Piperazinas/envenenamiento , Psilocibina/envenenamiento , Fumarato de Quetiapina , Oxibato de Sodio/envenenamiento , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Estados Unidos/epidemiologíaAsunto(s)
Acetaminofén/envenenamiento , Clorfeniramina/envenenamiento , Dextrometorfano/envenenamiento , Medicamentos sin Prescripción/envenenamiento , Fenilpropanolamina/envenenamiento , Trastornos Relacionados con Sustancias/fisiopatología , Combinación de Medicamentos , Sobredosis de Droga , Antagonistas de Aminoácidos Excitadores/envenenamiento , Humanos , N-Metilaspartato/antagonistas & inhibidores , Receptores de N-Metil-D-Aspartato/antagonistas & inhibidoresRESUMEN
CoricidinHBP (Schering-Plough Health Care Products, Inc, Memphis, TN) is a popular over-the-counter product abused by teenagers for its potent euphoric properties. Clinically significant signs and symptoms after ingestion are usually short-lived and commonly include tachycardia, hypertension, somnolence, and agitation. We report 2 cases of severe toxicity from CoricidinHBP in adolescents that required prolonged hospitalization. The first case demonstrates prolonged anticholinergic complications from a suicidal attempt with CoricidinHBP. The second case demonstrates significant acetaminophen-induced hepatotoxicty from recreational use of CoricidinHBP Maximum Strength Flu. Adolescent abuse of these products is encouraged because of the easily accessible medium of the Internet. The significant morbidity seen in our cases clearly demonstrates the need for vigilance by health care professionals regarding the abuse of over-the-counter products.
Asunto(s)
Acetaminofén/envenenamiento , Clorfeniramina/envenenamiento , Dextrometorfano/envenenamiento , Medicamentos sin Prescripción/envenenamiento , Fenilpropanolamina/envenenamiento , Trastornos Relacionados con Sustancias/diagnóstico , Adolescente , Antidepresivos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas , Depresión/tratamiento farmacológico , Combinación de Medicamentos , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/etiología , Sobredosis de Droga/terapia , Servicios Médicos de Urgencia/métodos , Femenino , Humanos , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
Coricidin products seemed to be one of the over-the-counter medications being reportedly abused by adolescents, as observed from the Texas Poison Center Network data. This retrospective chart review investigated the occurrence of abuse, developed a patient profile, and defined the clinical effects resulting from the abuse of Coricidin products. Data collected from the Texas Poison Center Network Toxic Exposure Surveillance System database included human exposures between 1998 and 1999, patients > or = 10y old, intentional use or abuse, and single substance ingestion of I of the tablet formulations of Coricidin. Thirty-three cases from 1998 and 59 cases from 1999 were reviewed. Of these cases, 85% met the inclusion criteria. Of the 7 medications searched, only 4 substances were coded for: Coricidin D, Coricidin D (long acting), Coricidin D (cold, flu & sinus) and Coriciding HBP. These contain a combination of dextromethorphan hydrobromide, chlorpheniramine maleate, phenylpropanolamine hydrochloride, and acetaminophen. Of the 78 cases, 63% were male and 38% were female. The mean age was 14.67 years, 77% being between 13 to 17 years old. Eighteen different symptoms were reported: tachycardia 50%, somnolence 24.4%, mydriasis and hypertension 16.7%, agitation 12.8%, disorientation 10.3%, slurred speech 9%, ataxia 6.4%, vomiting 5.1%, dry mouth and hallucinations 3.9%, tremor 2.6%, and headache, dizziness, syncope, seizure, chest pain, and nystagmus each 1.3%; 12.8% of the calls originated from the school nurse. The incidence of abuse reported increased 60% from 1998 to 1999. This worrisome trend suggests increased abuse of these products.
Asunto(s)
Acetaminofén/envenenamiento , Antitusígenos/envenenamiento , Clorfeniramina/envenenamiento , Dextrometorfano/envenenamiento , Medicamentos sin Prescripción/envenenamiento , Fenilpropanolamina/envenenamiento , Adolescente , Conducta del Adolescente , Factores de Edad , Niño , Bases de Datos Factuales , Combinación de Medicamentos , Sobredosis de Droga/epidemiología , Femenino , Humanos , Incidencia , Masculino , Registros Médicos , Vigilancia de la Población , Estudios Retrospectivos , Texas/epidemiologíaAsunto(s)
Trastornos Relacionados con Anfetaminas/diagnóstico , Descongestionantes Nasales/envenenamiento , Fenilpropanolamina/envenenamiento , Adolescente , Trastornos Relacionados con Anfetaminas/fisiopatología , Trastornos Relacionados con Anfetaminas/orina , Presión Sanguínea , Diagnóstico Diferencial , Femenino , Cefalea/etiología , Humanos , Medicamentos sin Prescripción/efectos adversos , Detección de Abuso de Sustancias , Vómitos/etiologíaRESUMEN
Over-the-counter (OTC) cough and cold medications are marketed widely for relief of common cold symptoms, and yet studies have failed to demonstrate a benefit of these medications for young children. In addition, OTC medications can be associated with significant morbidity and even mortality in both acute overdoses and when administered in correct doses for chronic periods of time. Physicians often do not inquire about OTC medication use, and parents (or other caregivers) often do not perceive OTCs as medications. We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. We explore the toxicities of OTC cough and cold medications, discuss mechanisms of dosing errors, and suggest why physicians should be more vigilant in specifically inquiring about OTCs when evaluating an ill child.
Asunto(s)
Antitusígenos/envenenamiento , Enfermedades Cardiovasculares/inducido químicamente , Medicamentos sin Prescripción/envenenamiento , Acetaminofén/envenenamiento , Bradicardia/inducido químicamente , Bromofeniramina/envenenamiento , Preescolar , Combinación de Medicamentos , Sobredosis de Droga , Resultado Fatal , Fiebre/inducido químicamente , Paro Cardíaco/inducido químicamente , Humanos , Hipertensión/inducido químicamente , Ibuprofeno/envenenamiento , Masculino , Fenilefrina/envenenamiento , Fenilpropanolamina/envenenamiento , Seudoefedrina , Fases del Sueño , Taquicardia/inducido químicamente , Vómitos/inducido químicamenteRESUMEN
Phenylpropanolamine is a sympathomimetic agent widely used in over-the-counter and prescription decongestant medications. We describe a young woman without cardiac risk factors who sustained myocardial infarction after unintentional overuse of a nasal decongestant containing phenylpropanolamine. The pathophysiology of myocardial injury and current management strategies as related to this agent are discussed. Although serious adverse reactions to phenylpropanolamine are uncommon, potentially serious harm may be caused by this widely available drug in healthy individuals.
Asunto(s)
Infarto del Miocardio/inducido químicamente , Descongestionantes Nasales/envenenamiento , Fenilpropanolamina/envenenamiento , Simpatomiméticos/envenenamiento , Adulto , Sobredosis de Droga , Electrocardiografía , Urgencias Médicas , Femenino , Humanos , Infarto del Miocardio/fisiopatologíaRESUMEN
El Ministerio de Salud de Nicaragua presenta resolución ministerial 157-2000 donde establece que todos los establecimientos farmacéuticos y No farmacias, deberán retirar de comercialización los productos que contienen Fenilpropanolamina.
Asunto(s)
Control de Medicamentos y Narcóticos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Fenilpropanolamina , Fenilpropanolamina/envenenamiento , Impactos de la Polución en la Salud , Preparaciones FarmacéuticasRESUMEN
Antihistamines are popular nonprescription medications for the treatment of allergy and cold symptoms. Accidental exposures to these preparations are common with > 14,000 occurring annually in children under the age of 6 years (1). Despite this, there is limited information about toxic and lethal concentrations of these drugs in children. We present a case of a pediatric fatality due to a common brompheniramine and phenylpropanolamine preparation and review available Pediatric Toxicology Registry data on alkylamine antihistamines. The data collected by the Pediatric Toxicology Registry on the drug phenylpropanolamine has been previously reported (2). A review of the Registry data suggests that postmortem blood brompheniramine concentrations of 0.4 mg/L and greater in children is indicative of brompheniramine poisoning. However, pheniramine was also present in the blood in the same case and may have caused an additive effect. The data are insufficient to establish the threshold of fatal blood pheniramine concentration in children. Data for chlorpheniramine are lacking.
Asunto(s)
Bromofeniramina/envenenamiento , Médicos Forenses , Antagonistas de los Receptores Histamínicos H1/envenenamiento , Pediatría , Sistema de Registros , Niño , Preescolar , Resultado Fatal , Femenino , Humanos , Lactante , Masculino , Fenilpropanolamina/envenenamiento , Estudios Retrospectivos , Sociedades MédicasRESUMEN
We report a case of a 17-years-old patient with an accidental ingestion of high doses of phenylpropanolamine. Nine hours after the ingestion she presented ventricular bigeminy and an episode of non sustained ventricular tachycardia. No cardiovascular disease was demonstrated.
Asunto(s)
Clorfeniramina/envenenamiento , Descongestionantes Nasales/envenenamiento , Fenilpropanolamina/envenenamiento , Compuestos de Amonio Cuaternario/envenenamiento , Taquicardia Ventricular/inducido químicamente , Adolescente , Preparaciones de Acción Retardada , Combinación de Medicamentos , Sobredosis de Droga/diagnóstico , Electrocardiografía/efectos de los fármacos , Urgencias Médicas , Femenino , Humanos , Intoxicación/diagnóstico , Taquicardia Ventricular/diagnósticoRESUMEN
A 14-year-old girl had evidence of an acute cardiomyopathy after a minimal overdose of phenylpropanolamine. She had myocardial dysfunction, ventricular dysrhythmia, and secondary pulmonary edema without any associated systemic hypertension. The cardiomyopathy resolved after several days.
Asunto(s)
Bromofeniramina/envenenamiento , Cardiomiopatías/inducido químicamente , Antagonistas de los Receptores Histamínicos H1/envenenamiento , Fenilefrina/envenenamiento , Fenilpropanolamina/envenenamiento , Adolescente , Combinación de Medicamentos , Sobredosis de Droga , Femenino , Humanos , SeudoefedrinaRESUMEN
The National Association of Medical Examiners (N.A.M.E.) has an ongoing project referred to as the Pediatric Toxicology (PedTox) Registry, which contains data for drugs and poisons detected in children. A recent PedTox Registry report on phenylpropanolamine (PPA) reported blood PPA concentrations in 12 dead children whose deaths were not attributed to PPA. Since that report, another article has been published describing plasma PPA concentrations in living children who were given PPA to evaluate its effect on incontinence. The 10 children in the incontinence study were older than most of the 12 deceased children whose PPA concentrations were reported in the PedTox Registry (10 of whom < or = 5 years of age). The plasma PPA levels observed in the incontinent children fell within the range of blood PPA concentrations reported in the PedTox Registry. Plasma PPA levels of up to 642 ng/ml (0.642 mg/L) were well tolerated in children > or = 6 years of age. Insufficient data exist to determine how similar blood PPA concentrations are tolerated by children < 6 years of age, although some data indicate that such levels may be well tolerated in the younger age group as well.