scholarly journals Cardiac arrest in a young healthy male patient secondary to kratom ingestion: is this ’legal high' substance more dangerous than initially thought ?

2019 ◽  
Vol 12 (7) ◽  
pp. e229778 ◽  
Author(s):  
Hafez Mohammad Ammar Abdullah ◽  
Iqra Haq ◽  
Randall Lamfers
Keyword(s):  
Cardiac Arrest ◽  
Adverse Effects ◽  
Systolic Dysfunction ◽  
Health Centre ◽  
Low Doses ◽  
Healthy Male ◽  
Brain Infarcts ◽  
Successful Recovery ◽  
Legal High ◽  
Higher Doses

Kratom is a psychoactive herb that has stimulant properties at low doses and has opioid-like properties at higher doses. It has been used for centuries in southeast Asia as a stimulant but has gained increasing popularity as a substitute for opioids in western countries as it is easily available. As most cases of kratom use involve other drugs too, the Food and Drug Administration (FDA) has stopped short of restricting kratom due to difficulty in assessing the adverse effects of kratom alone. We present the case of a young healthy 35-year-old man who suffered a cardiac arrest due to kratom use with no other coingestants. He was subsequently intubated and found to have systolic dysfunction and small brain infarcts. Fortunately, he made a successful recovery and was discharged after a stay at thebehavioural health centre. Our case highlights the potential adverse effects of kratom and the need to regulate its use.

Involvement of 5-Hydroxytryptamine in Platelet Aggregation In Vivo in Rats and Guinea Pigs

1989 ◽  
Vol 61 (03) ◽  
pp. 463-467 ◽  
Author(s):  
G M Smith
Keyword(s):  
Platelet Count ◽  
Guinea Pigs ◽  
Platelet Adhesion ◽  
Adenosine Diphosphate ◽  
Rate Of Return ◽  
Low Doses ◽  
Dose Dependent ◽  
Higher Doses ◽  
Rat Platelets

SummaryIn this study, 5-hydroxytryptamine (5-HT) caused a dose- dependent fall in the circulating platelet count suggesting that 5-HT receptors are activated in rat platelets to cause platelet adhesion and aggregation. When low doses of adenosine diphosphate (ADP) were simultaneously injected with 5-HT, there was a significant potentiation of the responses to ADR Ketanserin significantly reduced the potentiated responses. When higher doses of ADP were infused with bolus injections of 5-HT there was no potentiation and ketanserin did not reduce these responses. Ketanserin did not inhibit the collagen-induced fall in circulating platelet count, but did significantly increase the rate of return to the basal platelet count compared with control. 5-HT did not cause a fall in platelet count in guinea-pigs

Effect of insulin on free fatty acid uptake by hepatocytes in the duck

1984 ◽  
Vol 102 (3) ◽  
pp. 381-386 ◽  
Author(s):  
R. Gross ◽  
P. Mialhe
Keyword(s):  
Fatty Acids ◽  
Growth Hormone ◽  
Fatty Acid ◽  
Free Fatty Acid ◽  
Glucose Metabolism ◽  
Free Fatty Acids ◽  
Fatty Acid Uptake ◽  
Acid Uptake ◽  
Low Doses ◽  
Higher Doses

ABSTRACT To elucidate the hypolipacidaemic effect of insulin in ducks, its action on the uptake of free fatty acids (FFA) by duck hepatocytes was determined. At low doses (10 mu./l) insulin stimulated FFA uptake. This effect was not observed with higher doses of insulin (20, 30 and 50 mu./l). Growth hormone at physiological concentrations and corticosterone (14·4 nmol/l) decreased basal activity, probably by reducing glucose metabolism and consequently α-glycerophosphate (α-GP) supply. Insulin was able to reverse the inhibition induced by GH and corticosterone on both FFA uptake and α-GP production. These results therefore suggest that the hypolipacidaemic effect of insulin may be partly mediated by its action on hepatic FFA uptake. J. Endocr. (1984) 102, 381–386

Abstract 12933: Myocardial Dysfunction After In-Hospital Cardiac Arrest in COVID-19 Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Abhishek Bhardwaj ◽  
Mahmoud Alwakeel ◽  
Siddharth Dugar ◽  
sudhir krishnan ◽  
Xiaofeng Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Median Time ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Cleveland Clinic ◽  
Case Series ◽  
Apache Ii Score ◽  
Lv Function ◽  
Hospital Cardiac Arrest

Introduction: Post resuscitation myocardial dysfunction (PRMD) is common after out-of-hospital cardiac arrest. While PRMD is a known cause of post-resuscitation circulatory failure, few studies have reported associations between PRMD and neurologic outcome or survival. Further, little is known about PRMD after in-hospital cardiac arrest (IHCA) nor on the incidence and prognosis of PRMD in COVID-19 IHCA. We sought to evaluate the incidence of PRMD in a multicenter cohort of resuscitated COVID-19 IHCA patients. Study Population and Methods: We included adult patients (≥18 y) admitted to multiple hospitals of Cleveland Clinic Health System. Patients who attained ROSC with an initial echocardiogram (EC) in the 72 hours post-arrest were included. Data were extracted from a data registry and electronic medical records. Results: From 03/2020-10/2020, 58 patients with COVID-19 had IHCA. ROSC was noted in 35 patients (60.3%), 27 (46.6%) were alive at 24 h and 13 patients (22.4%) survived to hospital discharge. Of the 35 patients who had ROSC, 14 patients (40%) had an EC within 72 h. The median age of this cohort was 67 y (IQR 47 - 73); 71% were male, and median BMI of 28 (IQR 27 - 34), and admission APACHE II score was 13 (IQR 11 - 19). One third of the patients (36%) were mechanically ventilated before arrest and 43% were on vasopressors. Initial arrest rhythms were: PEA/Asystole, 79%; and VF/VT, 21%. Most patients (93%) received manual chest compression with median CPR duration of 5 min (IQR 2 - 10). The median time of obtaining first EC post-ROSC in these 14 patients was 22 hours (IQR 6 - 62). 7/14 (50%) of the patient had systolic dysfunction on initial EC (6 had global dysfunction, 1 with regional wall motion abnormality, and 4/7 had combined LV and RV systolic dysfunction). 5/14 patients had a follow up EC with a median time of 43 days. 2/5 had normal initial EC and 3 out of these 5 patients who initially had PMRD showed complete recovery in their LV and RV systolic function. Conclusion: We report a case series of PRMD in COVID-19 patients who experienced IHCA. We found that PMRD is seen in half of the patients. Most patients with PMRD recovered to normal RV and LV function, consistent with prior studies of non-COVID-19 arrest EC.

scholarly journals Head-down tilt position successfully prevent severe brain air embolism

2018 ◽  
Vol 6 ◽  
pp. 2050313X1880926 ◽  
Author(s):  
Gaku Yamaguchi ◽  
Hiroyuki Miura ◽  
Eiji Nakajima ◽  
Norihiko Ikeda
Keyword(s):  
Cardiac Arrest ◽  
Low Temperature ◽  
Brain Damage ◽  
Air Embolism ◽  
Cardiac Massage ◽  
Open Chest ◽  
Successful Recovery ◽  
Life Threatening ◽  
Margin Detection ◽  
Air Embolus

Air embolisms are rare life-threatening complications that develop under various conditions, including surgery. During segmentectomy for thoracic surgery, air is blown into the selected bronchus for segment margin detection. This may result in the formation of an air embolus. Herein, we report a case of successful recovery from sudden intraoperative cardiac arrest due to an air embolism in a patient undergoing left superior division segmentectomy via open thoracotomy. Intraoperatively, the patient was positioned head-down. Upon blowing air into the bronchus, the patient suddenly developed cardiac arrest. Open-chest cardiac massage and low-temperature therapy were commenced and the patient recovered. The head-down position prevents the air embolus from reaching the brain and thus prevents severe brain damage, whereas continuous open-chest massage and low temperature prevents severe body damage from anticipated cardiac air embolism. Thus, operation in the head-down position is useful in preventing severe brain damage from brain air embolisms.

scholarly journals Successful resuscitation of the patient on extended tocolytic therapy subjected to an urgent cesarean section

2002 ◽  
Vol 59 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Biljana Djordjevic ◽  
Milos Stojiljkovic ◽  
Tatjana Potpara ◽  
Dragana Loncar-Stojiljkovic ◽  
Ljiljana Vojvodic
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Ischemia ◽  
Adverse Effects ◽  
Cesarean Section ◽  
Maintenance Therapy ◽  
General Anesthesia ◽  
Preterm Labor ◽  
Intravenous Therapy ◽  
Successful Resuscitation ◽  
The Usa

Ritodrine is the only medicament approved by FDA in the USA as well as in our country for prevention of the threatening preterm labor. Its adverse effects upon the respiratory and cardiovascular systems, including pulmonary edema and myocardial ischemia, occur more frequently during the intravenous therapy than during the oral maintenance therapy. The aim of this report was to present a patient with cardiovascular adverse effects of ritodrine, who had her pregnancy terminated by an urgent cesarean section under general anesthesia. In the course of operation, the patient had two cardiac arrest (total of 70 min). Resuscitation was performed by direct and indirect heart massage. The patient's condition was stabilized during the next six hours. The patient was transferred to the coronary unit, where the treatment was continued for 30-days period, after which the patient was released home as completely recovered.

Abstract 18294: Left Ventricular Systolic Dysfunction Early After Resuscitation From Cardiac Arrest is Associated With Shockable Arrest Rhythm

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jacob C Jentzer ◽  
Hussein Abu-Daya ◽  
Asher Shafton ◽  
Meshe Chonde ◽  
Didier Chalhoub ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Troponin I ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Mitral Annulus Velocity ◽  
Fractional Shortening

Introduction: Left ventricular systolic dysfunction (LVSD) is common after resuscitation from cardiac arrest (CA). The association of echocardiographic LVSD with cardiac rhythm during CA is not well described. Hypothesis: Patients with a shockable rhythm (VT/VF) will have a greater degree of LVSD by echocardiography after CA. Methods: Prospective registry of patients resuscitated from CA underwent transthoracic echocardiography (TTE) within 24 hours after CA. We determined 2D measurements, LVEF, spectral Doppler of mitral inflow and LV outflow, systolic and diastolic tissue Doppler of the mitral annulus velocity, and tricuspid plane annular excursion (TAPSE). We collected data on in-hospital mortality as well as vasopressor doses and troponin I levels. TTE parameters and clinical characteristics were compared between patients with a shockable (VT/VF) arrest rhythm and a non-shockable (asystole/PEA) arrest rhythm and between survivors and non-survivors using t-tests and ANOVA. Results: Of the 55 patients, the 23 (42%) with shockable CA rhythms had significantly higher LV end-systolic dimension (4.1cm vs. 3.3cm, p = 0.0073), lower LV fractional shortening (0.15 vs. 0.28, p <0.0001), and lower LVEF both by visual estimate (36.2% vs. 52.3%, p = 0.0012) and by Simpson’s biplane method (37.5% vs. 52.3%, p = 0.0506). Other measured TTE parameters did not differ between groups, including TAPSE (shockable 1.53 vs. non-shockable 1.82, p = 0.1731). Admission and peak 24 hour vasopressor requirements did not differ between groups. Peak troponin levels were higher (22.26 vs. 3.88, p = 0.0198) in patients with shockable CA rhythms, but admission troponin levels were no different (0.88 vs. 0.51, p = 0.1527). TTE parameters did not differ between survivors and non-survivors (visual LVEF 47.0% vs. 44.2%, p = 0.5968; LV fractional shortening 0.19 vs. 0.25, p = 0.0916). Conclusions: Patients with shockable CA rhythms have more severe LVSD on 24 hour echocardiography despite similar vasopressor requirements and admission troponin levels. Echocardiographic parameters at 24 hours did not predict in-hospital mortality. Early echocardiography after CA appears more useful for differentiating primary CA rhythm than for predicting mortality.

Effect of methacholine chloride on rheology and transport of canine tracheal mucus

1979 ◽  
Vol 47 (1) ◽  
pp. 26-31 ◽  
Author(s):  
M. King ◽  
N. Viires
Keyword(s):  
Mechanical Properties ◽  
Elastic Modulus ◽  
Base Line ◽  
Low Doses ◽  
Mucociliary Transport ◽  
Frog Palate ◽  
High Doses ◽  
Tracheal Mucus ◽  
Higher Doses ◽  
Cytology Brush

The effect of methacholine chloride (M) on tracheal mucus was investigated in three conscious tracheostomized dogs. Aerosols of M in concentrations of 2--32 mg/ml were delivered intratracheally for 1 min. Mucus was sampled with a cytology brush at 2 min postchallenge and at irregular intervals thereafter. The mechanical properties of each sample were determined in the magnetic microrheometer, and correlated with mucociliary transportability as assayed by the frog palate technique. With high doses of M, there was an increase in volume of secretion collected per unit time. The elastic modulus (G′) at 2 min postchallenge went up (to 1.5 x 2.3 x control for 16 and 32 mg/ml, respectively) then fell below control before returning to base line after 30 or 45 min. With low doses of M (2--8 mg/ml) the secretion rate was also above control, but only a decrease in G′ (to 0.54 x control) was observed. The decrease in G′ at low doses did not significantly alter the frog palate transport rate; however, the increase at higher doses did impede mucociliary transport.

Effects of acetazolamide and metabolic acidosis and alkalosis upon gastric acid secretion

1962 ◽  
Vol 202 (3) ◽  
pp. 429-436 ◽  
Author(s):  
Frank M. Byers ◽  
Paul H. Jordan ◽  
Thomas H. Maren
Keyword(s):  
Metabolic Acidosis ◽  
Carbonic Anhydrase ◽  
Acid Secretion ◽  
Metabolic Alkalosis ◽  
Suppressive Effect ◽  
Low Doses ◽  
Heidenhain Pouch ◽  
Feeding Experiments ◽  
Initial Reduction ◽  
Higher Doses

The gastric H+ secretory responses to i.v. HCl, NaHCO3, and acetazolamide were studied in Heidenhain-pouch dogs that had been stimulated to secrete by feeding. Acetazolamide in low doses (5 mg/kg) gave a 65% reduction in H+ output for 2–4 hr, after which H+ secretion increased above normal, coincident with renal HCO3– loss and metabolic acidosis. Higher doses produced a greater systemic acidosis and resulted in less initial reduction of H+ and greater augmentation. Doses of 75–100 mg/kg, given 17 hr before feeding to produce a systemic acidosis, resulted in increased secretion, even though sufficient drug remained in the plasma to inhibit tissue carbonic anhydrase. Metabolic acidosis (i.v. HCl) initially suppressed but later augmented gastric H+. Acetazolamide had no suppressive effect in the presence of either an HCl- or acetazolamide-induced acidosis. Metabolic alkalosis (i.v. NaHCO3) reduced gastric H+ in regular feeding experiments and in dogs made acidotic by acetazolamide.

scholarly journals The action of prolyl-leucyl-glycinamide (PLG) on the nigrostriatal pathway of the rat

1990 ◽  
Vol 48 (2) ◽  
pp. 156-160
Author(s):  
João S. Pereira ◽  
Luiz Augusto F. Andrade ◽  
Paulo H. F. Bertolucci ◽  
J. Geraldo Camargo Lima ◽  
Henrique B. Ferraz
Keyword(s):  
Wistar Rats ◽  
Electrolytic Lesion ◽  
Behavior Model ◽  
Low Doses ◽  
Nigrostriatal Pathway ◽  
Rem Sleep Deprivation ◽  
Hypothalamic Region ◽  
Male Wistar Rats ◽  
6 Hydroxydopamine ◽  
Higher Doses

In order to study the nigrostriatal pathway, we obtained the rotatory behavior model in male Wistar rats by electrolytic lesion of the left lateral hypothalamic region. Animals thus lesioned displayed rotations toward the same side of lesion when apomorphine was administered, a result in disagreement with what has been obtained in the model with 6-hydroxydopamine lesion. The administration of PLG alone was not followed by rotatory behavior but when the compound was administered in low doses (0.25 to 1mg/kg) simultaneously with apomorphine to animals previously submitted to REM sleep deprivation, a significant increase in the number of rotations was observed in comparison with controls and groups receiving higher doses of PLG. These results indicate that PLG may act as, a modulator on dopamine receptors in the striatum.

Influence of High-Dose Folic Acid on Methotrexate Efficacies and Safety in Japanese Rheumatoid Arthritis Patients

Drug Research ◽  
2017 ◽  
Vol 67 (12) ◽  
pp. 705-709 ◽  
Author(s):  
Shun Kameyama ◽  
Yuko Kase ◽  
Saori Kurihara ◽  
Fumiko Yoshida ◽  
Masamitu Noda ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Folic Acid ◽  
Adverse Effects ◽  
Patient Characteristics ◽  
High Dose ◽  
Major Conclusion ◽  
Dose Methotrexate ◽  
Higher Doses ◽  
Patient Subgroups

Abstract Backgrounds Folic acid dose at ≦5 mg/week has been recommended for rheumatoid arthritis (RA) patients to decrease risk of methotrexate adverse effects. However, higher doses of folic acid is used in some cases. We examined the influence of high-dose folic acid on methotrexate efficacies and safety in Japanese RA patients. Methods 502 RA patients of four hospitals prescribed methotrexate and folic acid were included. These patients were divided into two subgroups according to the threshold of folic acid dose by 5 mg/week. Basic patient characteristics, methotrexate doses, and the efficacies or adverse effects of methotrexate were retrospectively compared between the two patient subgroups. Results The frequency of folic acid use at doses higher than 5 mg/week was significantly different between the four hospitals (P<0.001). The prevalence of methotrexate adverse effects was not significantly different between the patients taking folic acid less and more than 5 mg/week. However, in the lower dose methotrexate subgroup (≦8 mg/week), the prevalence of patients exhibiting abnormal serum ALT concentrations in the patients using higher (>5 mg/week) dose of folic acid was significantly higher than that in the lower (≦5 mg/week) folic acid-treated subgroup (P=0.029). Folic acid dose between patients taking methotrexate less and more than 8 mg/week was not significantly different. Major conclusion Folic acid dose was dependent on the hospitals, while efficacies and hepatotoxicity of methotrexate was not basically different between patients taking less and more than 5 mg/week of folic acid.

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