Qua-Alluding to the Past: A Case of Methaqualone Analog Ingestion

Abstract Methaqualone, known previously under the brand name Quaalude, is a Schedule I sedative hypnotic drug that may cause neurotoxicity in overdose, characterized by somnolence, hyperreflexia and muscular hyperactivity. We present a case of a 21-year-old male who reportedly ingested methaqualone in addition to insufflation of street cocaine. He subsequently developed hypoxia, hyperreflexia, myoclonus, and altered mental status. His laboratory results were notable for the presence of methemoglobinemia, which was most likely due to a cocaine contaminant. Laboratory analysis of the alleged methaqualone pills identified the substance as SL-164, a dichlorinated methaqualone analog. Urine toxicology results were positive for SL-164 (and presumed metabolites) as well as for cocaine and tetrahydrocannabinol metabolites. The patient was treated with supplemental oxygen and a benzodiazepine (lorazepam) and observed in the Emergency Department (ED) until his symptoms resolved. This case highlights current community access to methaqualone analogs. The case also focuses on laboratory techniques used to identify the methaqualone analog.

Download Full-text

Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.4.41878 ◽

2019 ◽

Vol 3 (3) ◽

pp. 252-255 ◽

Cited By ~ 1

Author(s):

Marco Elegante ◽

Joseph Hamera ◽

Jane Xiao ◽

David Berger

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Pulmonary Edema ◽

Mental Status ◽

Cerebral Edema ◽

Altered Mental Status ◽

Supplemental Oxygen ◽

Hysteroscopic Myomectomy ◽

Operative Hysteroscopy ◽

Intravenous Saline

Operative hysteroscopy intravascular absorption syndrome is an iatrogenic syndrome caused by absorption of hypo-osmolar distension medium during hysteroscopy, which can lead to rapid hyponatremia with resulting cerebral and pulmonary edema. We present a case of a 47-year-old female who underwent hysteroscopic myomectomy at an outpatient ambulatory surgical center who was brought to the emergency department with dyspnea, hypoxia, and altered mental status. Workup showed hyponatremia with cerebral edema on computed tomography of the head and pulmonary edema on chest radiograph. The patient improved after resuscitation with intravenous saline and supplemental oxygen, and she was discharged home the next day.

Download Full-text

A Case Report of Clobazam Toxicity Related to Cannabidiol and Clobazam Drug-drug Interaction

Translation: The University of Toledo Journal of Medical Sciences ◽

10.46570/utjms.vol6-2019-339 ◽

2019 ◽

Vol 6 ◽

pp. 35-36

Author(s):

Rowida Kheireldin

Keyword(s):

Emergency Department ◽

Drug Interaction ◽

Mental Status ◽

Reference Range ◽

Altered Mental Status ◽

Dravet Syndrome ◽

The Past ◽

Drug Drug Interaction ◽

Convulsive Seizures ◽

Remarkable Reduction

The interest in the anti-seizure efficacy of cannabinoids (CBD)has significantly increased over the past decade. Trials have shown a remarkable reduction in the frequency of convulsive seizures in Dravet and Lennox-Gastaut syndromes patient population. Studies have shown that CBD reacts with Clobazam leading to a significant increase in the levels of N-desmethylclobazam, the active metabolite of Clobazam. We present a case of a patient with Dravet syndrome who presented to the emergency department with altered mental status secondary to Clobazam toxicity related to CBD and Clobazam drug-drug interaction. We present a case of a patient with Dravet syndrome who presented to the emergency department with altered mental status. Patient was hospitalized and Clobazam was held off. Clobazam level and N-desmethylclobazam levels were obtained and came back elevated at 512 ng/mL and 15020 ng/mL respectively (reference range 30-300 ng/mL and 300 to 3000 ng/mL respectively). Rowida Kheireldin (a) (1) Naeem Mahfooz (b)

Download Full-text

Starch-modified fillers for linerboard and paper grades: A perspective review

TAPPI Journal ◽

10.32964/tj9.4.31 ◽

2010 ◽

Vol 9 (4) ◽

pp. 31-36 ◽

Cited By ~ 11

Author(s):

YULIN DENG ◽

PHIL JONES ◽

LESLIE MCLAIN ◽

ART J. RAGAUSKAS

Keyword(s):

Filler Content ◽

Product Platform ◽

Laboratory Studies ◽

The Past ◽

Development Opportunity ◽

Laboratory Results ◽

Addition Rate ◽

Institute Of Technology ◽

Paper Product ◽

Detrimental Impact

High-filler-content paper is a growing research and development opportunity in papermaking. These new products must address traditional paper product properties while providing papermakers with distinct product platform benefits. Over the past decade, a research team involving researchers from the Institute of Paper Science and Technology at Georgia Institute of Technology and from Imerys have significantly advanced the application of starch-encapsulated papermaking fillers. This review summarizes these accomplishments from initial laboratory studies to mill trials. Laboratory results have illustrated that starch-encapsulated fillers can facilitate a near-doubling of filler content over conventional levels at equal tensile and z-direction tensile (ZDT) values. Equally important is that the use of starch-encapsulated kaolin (SEK) filler has been shown to facilitate a doubling of filler addition rate without any detrimental impact on ring crush compared with control studies with filler. Pilot-plant and mill trials have shown that SEK can function as a fiber extender, reduce steam demand for drying by 10%, and increase papermaking speeds and production rates.

Download Full-text

Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis

PEDIATRICS ◽

10.1542/peds.2011-0889d ◽

2012 ◽

Vol 129 (3) ◽

pp. X19-X19

Keyword(s):

Emergency Department ◽

Supplemental Oxygen

Download Full-text

Organophotoredox-Catalyzed C–H Alkylation of Imidazoheterocycles with Malonates: Total Synthesis of Zolpidem

Synthesis ◽

10.1055/s-0040-1706103 ◽

2020 ◽

Author(s):

Narendra R. Chaubey ◽

Anant R. Kapdi ◽

Biswanath Maity

Keyword(s):

Total Synthesis ◽

Room Temperature ◽

Drug Molecule ◽

Bond Functionalization ◽

First Report ◽

Mild Conditions ◽

The Past ◽

Hypnotic Drug ◽

Free Environment

AbstractOrganophotocatalytic C–H bond functionalization has attracted a lot of attention in the past several years due to the possibility of catalyzing reactions in a metal- and peroxide-free environment. Continuing on these lines, an organophotoredox-catalyzed C–H functionalization of imidazo[1,2-a]pyridines and related heterocycles with bromomalonates under mild conditions is reported, providing excellent yields of the products at room temperature. This is the first report involving malonates as coupling partners leading to the synthesis of a range of functionalized products including total synthesis of zolpidem, a sedative-hypnotic drug molecule.

Download Full-text

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.

Download Full-text

Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa537 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Lindsay A Petty ◽

Valerie M Vaughn ◽

Scott A Flanders ◽

Twisha Patel ◽

Anurag N Malani ◽

...

Keyword(s):

Emergency Department ◽

Antibiotic Treatment ◽

Asymptomatic Bacteriuria ◽

Antibiotic Use ◽

Altered Mental Status ◽

Estimating Equation ◽

Hospitalized Patients ◽

Clostridioides Difficile ◽

Cord Injury ◽

Clostridioides Difficile Infection

Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. Methods We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018–February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Results Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08–1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P = .02). Conclusions Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.

Download Full-text

Recurrent Thrombotic Vasculopathy in a Former Cocaine User

Case Reports in Dermatological Medicine ◽

10.1155/2015/763613 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Preeti Jadhav ◽

Hassan Tariq ◽

Masooma Niazi ◽

Giovanni Franchin

Keyword(s):

Clinical Presentation ◽

Rehabilitation Program ◽

The Body ◽

Drug Rehabilitation ◽

Cocaine User ◽

Cocaine Use ◽

The Past ◽

Urine Toxicology ◽

History Of ◽

Infectious Etiology

We report a case of a 35-year-old female who presented to the emergency room (ER) complaining of a pruritic rash involving multiple areas of the body. She had a significant history of cocaine use in the past. She had first developed a similar rash in 2013 when she was diagnosed with cocaine-induced vasculitis. Her urine toxicology had been positive for cocaine in the past until July 2013. She was incarcerated and attended a drug rehabilitation program after which she quit cocaine use, which was consistent with negative urine toxicology on subsequent admissions. Further workup did not reveal any other, autoimmune or infectious, etiology of this clinical presentation. The patient underwent biopsy of the skin lesion that was consistent with thrombotic vasculopathy likely secondary to levamisole.

Download Full-text