Dexmedetomidine to Treat 3, 4-Methylenedioxymethamphetamine-Induced Agitation in a 13-Month-Old Infant: A Case Report and Literature Review

AbstractWe report a 13-month-old infant who accidentally ingested a tablet of 3, 4-methylenedioxymethamphetamine (MDMA) and was brought to the emergency department with tachycardia, seizures, mydriasis, and altered mental status. The patient received multiple doses of benzodiazepines to treat the seizures and developed respiratory insufficiency needing intubation. After extubation, the patient developed hyperactivity, myoclonic, and choreoathetoid movements which were unresponsive to benzodiazepines. Dexmedetomidine was started with good response. The patient made a full clinical recovery. This is the first case that illustrates the possibility to treat MDMA-induced agitation with dexmedetomidine in a 13-month-old infant.

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Confusional State in HaNDL Syndrome: Case Report and Literature Review

Case Reports in Neurological Medicine ◽

10.1155/2013/317685 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Sarah Nelson

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Literature Review ◽

Mental Status ◽

Clinical Manifestation ◽

English Language ◽

Altered Mental Status ◽

Confusional State ◽

Limited Condition ◽

Confusional States

The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition. Confusional states are uncommonly reported as a clinical manifestation of this syndrome. Here, I report a 76-year-old female who presented with headache, confusion, and agitation with a mild CSF lymphocytosis. Other workup to determine the cause of her altered mental status was otherwise negative. The literature available in the English language on HaNDL syndrome is reviewed, including its history, pathophysiology, possible associations with migraine and stroke, and previously reported cases of confusional states in this syndrome. While HaNDL syndrome has been a described entity since the 1980s, its pathophysiology has yet to be clearly defined.

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Moyamoya as a Cause of Altered Mental Status in the Emergency Department: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.10.49415 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Michael West ◽

Elizabeth Dearing

Keyword(s):

Emergency Department ◽

Case Report ◽

Mental Status ◽

Altered Mental Status

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Does Advanced Life Support Provide Benefits to Patients?: A Literature Review

Prehospital and Disaster Medicine ◽

10.1017/s1049023x0000265x ◽

2005 ◽

Vol 20 (4) ◽

pp. 265-270 ◽

Cited By ~ 26

Author(s):

Derek L. Isenberg ◽

Richard Bissell

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Cardiac Arrest ◽

Literature Review ◽

Mental Status ◽

Life Support ◽

Advanced Life Support ◽

Altered Mental Status ◽

Trauma Patients ◽

Early Defibrillation

AbstractIntroduction:Emergency medical services have invested substantial resources to establish advanced life support (ALS) programs. However, it is unclear whether ALS care provides better outcomes to patients compared to basic life support (BLS) care.Objective:To evaluate the current evidence regarding the benefits of ALS.Methods:Electronic medical databases were searched to identify articles that directly compared ALS versus BLS care. A total of 455 articles were found. Articles were excluded for the following reasons: (1) the article was not written in English; (2) BLS response was not compared to an ALS response; (3) a physician or nurse was included as part of the ALS response; (4) it was an aeromedical response; or (5) defibrillation was included in the ALS, but not the BLS, scope of care. Twenty-one articles met the inclusion criteria for this literature review.Results:Results were divided into four categories: (1) trauma; (2) cardiac arrest; (3) myocardial infarction; and (4) altered mental status.Trauma:The majority of articles showed that ALS provided no benefits over BLS in urban trauma patients. In fact, most studies showed higher mortality rates for trauma patients receiving ALS care. Further research is needed to evaluate the benefits of ALS for rural trauma patients, and whether ALS care improves outcomes in subgroups of urban trauma patients.Cardiac Arrest:Cardiac arrest studies show that early CPR plus early defibrillation provide the greatest improvement in survival. However, most cardiac arrest research includes defibrillation as an ALS skill which has now moved into the BLS scope of care. The 2004 multi-center OPALS study provided good evidence that ALS does not improve cardiac arrest survival over early defibrillation. Further research is needed to address whether any ALS interventions improve cardiac arrest outcome.Myocardial Infarction:Only one study directly compared the outcome of BLS and ALS care on myocardial infarction. The study found no difference in outcomes between BLS and ALS care in an urban setting.Advanced Life Support:Only one study directly compared the outcome of BLS and ALS care on patients with altered mental status. The study found that the same number of patients had improved to “alert” on arrival at the emergency department, but there was a decreased length of emergency department stay for patients treated by ALS for hypoglycemia.Limitations:This review article does not take into account the benefits of ALS interventions, such as thrombolytics, dextrose, or nitroglycerin, since no studies directly compared these interventions to BLS care. Furthermore, only one study in this literature review was a large, multi-center trial.Conclusions:ALS shows little, if any, benefits for urban trauma patients. Cardiac arrest studies show that ALS does not provide additional benefits over BLS-defibrillation care, but more research is needed in this area. In two small studies, ALS care did not provide benefits over BLS care for patients with myocardial infarctions or altered mental status. Larger-scale studies are needed to evaluate which specific ALS interventions improve patient outcomes.

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Delirium Associated with Salicylate and Acetaminophen Overdose in a Patient with COVID-19: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.8.48559 ◽

2020 ◽

Vol 4 (4) ◽

pp. 517-520

Author(s):

Tyler Wen ◽

Jason Chu ◽

Danielle Allenspach ◽

David Van

Keyword(s):

Emergency Department ◽

Central Nervous System ◽

Nervous System ◽

Case Report ◽

Mental Status ◽

Clinical Manifestations ◽

Altered Mental Status ◽

Psychosocial Stressors ◽

Acetaminophen Overdose ◽

Wide Range

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created numerous clinical challenges for physicians, in part due to its wide range of clinical manifestations and associated complications. Case Report: Here we present the case of a 69-year-old man who was admitted to the emergency department with fever, dyspnea, and altered mental status. We believe the patient’s condition was precipitated by a COVID-19 infection-induced delirium, a setting in which he ingested aspirin and acetaminophen in overdose that required lifesaving interventions. Conclusion: This case illustrates the potential for neuropsychiatric effects in COVID-19 patients due to both direct viral central nervous system pathology and pandemic-related psychosocial stressors.

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A Chemist with a Strange Etiology of Rhabdomyolysis: A Case Report of a Rare Toxicological Emergency

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.7.52923 ◽

2021 ◽

Vol 5 (4) ◽

pp. 432-435

Author(s):

Rajadurai Meenakshisundaram ◽

Joshua Joseph ◽

Prabakaran Perumal ◽

Akmal Areeb ◽

Prathap Pancheti ◽

...

Keyword(s):

Emergency Department ◽

Case Report ◽

Mental Status ◽

Creatine Phosphokinase ◽

Altered Mental Status ◽

Protective Equipment ◽

General Anaesthetic ◽

Airway Protection ◽

Halogenated Hydrocarbon ◽

Adequate Knowledge

Introduction: Chloroform, a halogenated hydrocarbon, causes central nervous depression, hepatotoxicity, nephrotoxicity, and rhabdomyolysis. Historically, chloroform had been used as a general anaesthetic and today is still used in chemical industries. Lack of proper personal protective equipment and adequate knowledge about its toxic effects can lead to serious harm. Case report: A 33-year-old gentleman presented to the emergency department (ED) with altered mental status. Given his depressed mental status, the decision was made to intubate shortly after arrival for airway protection. Further history raised suspicion of occupational chloroform exposure. Brown-colored urine further strengthened suspicion of chloroform poisoning with resultant rhabdomyolysis. Forced alkaline diuresis and N-acetylcysteine were started in the ED. His mental status and respiratory efforts improved on hospital day two, and he was ultimately extubated. Creatine phosphokinase and myoglobin levels were initially high but gradually came down by hospital day six. On hospital day 10, the patient was deemed stable and safely discharged. Conclusion: A patient with chloroform inhalation who suffered resultant rhabdomyolysis and hepatotoxicity was successfully treated with early initiation of forced alkaline diuresis, N-acetylysteine, and hemodialysis.

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Transient altered mental status and leptomeningeal enhancement associated with pembrolizumab: a case report

Neurological Sciences ◽

10.1007/s10072-021-05479-6 ◽

2021 ◽

Author(s):

Keng Lam ◽

Sameer K. Kulkarni ◽

Manya Khrlobyan ◽

Pamela K. Cheng ◽

Caroline L. Fong

Keyword(s):

Case Report ◽

Mental Status ◽

Altered Mental Status ◽

Leptomeningeal Enhancement

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Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02842-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

T. M. Skipina ◽

S. Macbeth ◽

E. L. Cummer ◽

O. L. Wells ◽

S. Kalathoor

Keyword(s):

Emergency Department ◽

Metabolic Acidosis ◽

Mental Status ◽

Rare Case ◽

Liver Function Tests ◽

Altered Mental Status ◽

Potassium Citrate ◽

Metabolic Encephalopathy ◽

History Of ◽

Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

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