scholarly journals Bowel perforation after single-dose activated charcoal

CJEM ◽  
2006 ◽  
Vol 8 (05) ◽  
pp. 358-360 ◽  
Author(s):  
Jason P. Green ◽  
William McCauley
Keyword(s):  
Emergency Department ◽  
Single Dose ◽  
Case Report ◽  
Adverse Effects ◽  
Drug Overdose ◽  
Activated Charcoal ◽  
Literature Search ◽  
Bowel Perforation ◽  
Gastrointestinal Decontamination

ABSTRACT Patients presenting to the emergency department (ED) after medication overdose are often given activated charcoal initially for gastrointestinal decontamination. Complications of charcoal are rare, but do occur. The following case describes a patient with pre-existing undiagnosed diverticular disease who developed sigmoid perforation after a single dose of activated charcoal, given without cathartic for a drug overdose. A literature search revealed no other cases of bowel perforation associated with single-dose activated charcoal. This case report discusses adverse effects associated with activated charcoal and the role of cathartics in gastrointestinal decontamination.

scholarly journals Steroid-induced psychosis in a child with croup: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110534
Author(s):  
Abdullrahman Alsalamah ◽  
Saud Alsahali
Keyword(s):  
Emergency Department ◽  
Single Dose ◽  
Case Report ◽  
Adverse Effects ◽  
Pediatric Population ◽  
Psychiatric History ◽  
Psychiatric Disturbances ◽  
Rare Side Effect ◽  
Abnormal Behaviors ◽  
Respiratory Complaints

Corticosteroids are effective for the treatment of many chronic and acute diseases but have many well-known adverse effects, which limit their use in some conditions. Steroid-induced psychosis is a rare side effect especially in the pediatric population. Although the estimated incidence of steroid-induced psychosis in adults is approximately 6%, it is rarely reported in the pediatric population. Moreover, it is poorly characterized and described in the literature. We report the case of a 4-year-old boy with no known medical or psychiatric history who presented to the emergency department with respiratory complaints. After observation and monitoring, the patient was diagnosed as having croup. A single dose of 8 mg dexamethasone was started intravenously. Within 3 h after the injection, the patient experienced psychiatric disturbances, including abnormal behaviors, anxiety, disorientation, decreased speech, and sleep disturbance. During the first 48 h of admission, the symptoms improved gradually, without using further medication during the rest of his hospital stay.

Overdose of Dologesic with a Fatal Outcome: A Case Report

2001 ◽  
Vol 8 (4) ◽  
pp. 207-211 ◽  
Author(s):  
CY Man
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Drug Overdose ◽  
Fatal Outcome ◽  
Common Cause ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Dologesic is a commonly prescribed analgesic in accident and emergency department. Yet report of overdose with this drug is not common. We report a case in which the patient developed cardiac arrest within an hour of ingestion. Dextropropoxyphene, a component of the drug Dologesic, used to be a common cause of fatalities after drug overdose in the seventies. It is highly toxic in overdose and therefore caution should be exercised when prescribing this drug.

scholarly journals Descriptive exploration of overdose codes in hospital and emergency department discharge data to inform development of drug overdose morbidity surveillance indicator definitions in ICD-10-CM

2021 ◽  
Vol 27 (S1) ◽  
pp. i27-i34
Author(s):  
Leigh M Tyndall Snow ◽  
Katelyn E Hall ◽  
Cody Custis ◽  
Allison L Rosenthal ◽  
Emilia Pasalic ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Drug Overdose ◽  
International Classification Of Diseases ◽  
Primary Diagnosis ◽  
Epidemiological Surveillance ◽  
Discharge Data ◽  
Aggregated Data ◽  
Data Coding ◽  
Icd 10

BackgroundIn October 2015, discharge data coding in the USA shifted to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), necessitating new indicator definitions for drug overdose morbidity. Amid the drug overdose crisis, characterising discharge records that have ICD-10-CM drug overdose codes can inform the development of standardised drug overdose morbidity indicator definitions for epidemiological surveillance.MethodsEight states submitted aggregated data involving hospital and emergency department (ED) discharge records with ICD-10-CM codes starting with T36–T50, for visits occurring from October 2015 to December 2016. Frequencies were calculated for (1) the position within the diagnosis billing fields where the drug overdose code occurred; (2) primary diagnosis code grouped by ICD-10-CM chapter; (3) encounter types; and (4) intents, underdosing and adverse effects.ResultsAmong all records with a drug overdose code, the primary diagnosis field captured 70.6% of hospitalisations (median=69.5%, range=66.2%–76.8%) and 79.9% of ED visits (median=80.7%; range=69.8%–88.0%) on average across participating states. The most frequent primary diagnosis chapters included injury and mental disorder chapters. Among visits with codes for drug overdose initial encounters, subsequent encounters and sequelae, on average 94.6% of hospitalisation records (median=98.3%; range=68.8%–98.8%) and 95.5% of ED records (median=99.5%; range=79.2%–99.8%), represented initial encounters. Among records with drug overdose of any intent, adverse effect and underdosing codes, adverse effects comprised an average of 74.9% of hospitalisation records (median=76.3%; range=57.6%–81.1%) and 50.8% of ED records (median=48.9%; range=42.3%–66.8%), while unintentional intent comprised an average of 11.1% of hospitalisation records (median=11.0%; range=8.3%–14.5%) and 28.2% of ED records (median=25.6%; range=20.8%–40.7%).ConclusionResults highlight considerations for adapting and standardising drug overdose indicator definitions in ICD-10-CM.

Management of Poisoning and Drug Overdose

2021 ◽  
Author(s):  
Timothy J Wiegand ◽  
Manish M Patel ◽  
Kent R. Olson
Keyword(s):  
Emergency Department ◽  
Drug Overdose ◽  
Activated Charcoal ◽  
Hospital Admissions ◽  
Clinical Laboratory ◽  
The United States ◽  
Emergency Department Visits ◽  
The Body ◽  
Smoke Inhalation ◽  
Drug Induced

Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.

Gastrointestinal Decontamination

1993 ◽  
Vol 6 (2) ◽  
pp. 48-56
Author(s):  
Gary M. Oderda
Keyword(s):  
Emergency Department ◽  
Gastric Emptying ◽  
Activated Charcoal ◽  
Gastric Lavage ◽  
Human Volunteers ◽  
Gastrointestinal Decontamination

Gastrointestinal decontamination plays an important role in the management of poisoned patients. The use of ipecac syrup has declined, and the use of activated charcoal has increased, during the period 1983 to 1991. If an emetic is used, ipecac syrup is the emetic of choice. If gastric emptying is done in an emergency department, gastric lavage is preferred. Recent studies in animals, human volunteers, and poisoned patients suggest that activated charcoal and a cathartic is as effective, or more effective, than ipecac or lavage plus activated charcoal and a cathartic. As such, activated charcoal and a cathartic should be considered the primary decontamination procedures to be used in a hospital.

scholarly journals Case Report: Dual nebulised antibiotics among adults with cystic fibrosis and chronic Pseudomonas infection

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2079
Author(s):  
Nina Mann ◽  
Shirley Murray ◽  
Zhe Hui Hoo ◽  
Rachael Curley ◽  
Martin J. Wildman
Keyword(s):  
Cystic Fibrosis ◽  
Case Report ◽  
Adverse Effects ◽  
Best Practice ◽  
Potential Role ◽  
Concomitant Administration ◽  
Intravenous Antibiotics ◽  
Inhaled Antibiotics ◽  
Pseudomonas Infection

Pulmonary exacerbations in adults with cystic fibrosis (CF) and chronic Pseudomonas aeruginosa (Psae) infection are usually treated with dual intravenous antibiotics for 14 days, despite the lack of evidence for best practice. Intravenous antibiotics are commonly associated with various systemic adverse effects, including renal failure and ototoxicity. Inhaled antibiotics are less likely to cause systematic adverse effects, yet can achieve airway concentrations well above conventional minimum inhibitory concentrations. Typically one inhaled antibiotic is used at a time, but dual inhaled antibiotics (i.e. concomitant use of two different inhaled antibiotics) may have synergistic effect and achieve better results in the treatment of exacerbations. We presented anecdotal evidence for the use of dual inhaled antibiotics as an acute treatment for exacerbations, in the form of a case report. A female in her early thirties with CF and chronic Psae infection improved her FEV1 by 5% and 2% with two courses of dual inhaled antibiotics to treat exacerbations in 2016. In contrast, her FEV1 changed by 2%, –2%, 0% and 2%, respectively, with four courses of dual intravenous antibiotics in 2016. Baseline FEV1 was similar prior to all six courses of treatments. The greater FEV1 improvements with dual inhaled antibiotics compared to dual intravenous antibiotics suggest the potential role of using dual inhaled antibiotics to treat exacerbations among adults with CF and chronic Psae infection, especially since a greater choice of inhaled anti-pseudomonal antibiotics is now available. A previous study in 1985 has looked at the concomitant administration of inhaled tobramycin and carbenicillin, by reconstituting antibiotics designed for parenteral administration. To our knowledge, this is the first literature to describe the concomitant use of two different antibiotics specifically developed for delivery via the inhaled route.

scholarly journals Case Report: Dual nebulised antibiotics among adults with cystic fibrosis and chronic Pseudomonas infection

F1000Research ◽  
2018 ◽  
Vol 6 ◽  
pp. 2079
Author(s):  
Nina Mann ◽  
Shirley Murray ◽  
Zhe Hui Hoo ◽  
Rachael Curley ◽  
Martin J. Wildman
Keyword(s):  
Cystic Fibrosis ◽  
Case Report ◽  
Adverse Effects ◽  
Best Practice ◽  
Potential Role ◽  
Concomitant Administration ◽  
Intravenous Antibiotics ◽  
Inhaled Antibiotics ◽  
Pseudomonas Infection

Pulmonary exacerbations in adults with cystic fibrosis (CF) and chronic Pseudomonas aeruginosa (Psae) infection are usually treated with dual intravenous antibiotics for 14 days, despite the lack of evidence for best practice. Intravenous antibiotics are commonly associated with various systemic adverse effects, including renal failure and ototoxicity. Inhaled antibiotics are less likely to cause systematic adverse effects, yet can achieve airway concentrations well above conventional minimum inhibitory concentrations. Typically one inhaled antibiotic is used at a time, but dual inhaled antibiotics (i.e. concomitant use of two different inhaled antibiotics) may have synergistic effect and achieve better results in the treatment of exacerbations. We presented anecdotal evidence for the use of dual inhaled antibiotics as an acute treatment for exacerbations, in the form of a case report. A female in her early thirties with CF and chronic Psae infection improved her FEV1 by 5% and 2% with two courses of dual inhaled antibiotics to treat exacerbations in 2016. In contrast, her FEV1 changed by 2%, –2%, 0% and 2%, respectively, with four courses of dual intravenous antibiotics in 2016. Baseline FEV1 was similar prior to all six courses of treatments. The greater FEV1 improvements with dual inhaled antibiotics compared to dual intravenous antibiotics suggest the potential role of using dual inhaled antibiotics to treat exacerbations among adults with CF and chronic Psae infection, especially since a greater choice of inhaled anti-pseudomonal antibiotics is now available. A previous study in 1985 has looked at the concomitant administration of inhaled tobramycin and carbenicillin, by reconstituting antibiotics designed for parenteral administration. To our knowledge, this is the first literature to describe the concomitant use of two different antibiotics specifically developed for delivery via the inhaled route.

scholarly journals Repeated Bowel Perforations with Ibuprofen Lysine: A Case Report

2008 ◽  
Vol 13 (3) ◽  
pp. 166-169
Author(s):  
Gregory J. Peitz ◽  
Eric B. Hoie ◽  
Shannon Hoy ◽  
Ann Anderson-Berry
Keyword(s):  
Case Report ◽  
Adverse Effects ◽  
Patent Ductus Arteriosus ◽  
Premature Infant ◽  
Medical Management ◽  
Bowel Perforation ◽  
Ductus Arteriosus ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Patent Ductus

Non-steroidal anti-inflammatory drugs (NSAID) have been used to close the patent ductus arteriosus in neonates for over two decades. Ibuprofen lysine, a parenteral NSAID, is labeled for the treatment of patent ductus arteriosus in neonates who do not respond to conventional medical management. While sharing many of the same adverse effects as indomethacin, spontaneous bowel perforation has not been reported. We describe a premature infant that experienced isolated bowel perforations after treatment with ibuprofen lysine for symptomatic patent ductus arteriosus.

scholarly journals Role of Bedside Ultrasound in CMV Retinitis: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Lauren Westafer ◽  
L. Connor Nickels ◽  
Eike Flach ◽  
Giuliano De Portu ◽  
Latha Ganti Stead
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Retinal Detachment ◽  
Bedside Ultrasound ◽  
Cmv Retinitis ◽  
Bedside Ultrasonography

We present a case of retinal detachment diagnosed by emergency department bedside ultrasonography in a patient with CMV retinitis. The indications and findings of ocular ultrasonography are discussed.

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