Prolonged unconsciousness in perampanel overdose

Clinical experience of perampanel overdoses is markedly limited and the relevant literature is sparse. Perampanel is a novel antiepileptic drug (an amino-3-hydroxy-5-methyl-4-isoxazlepropionic acid glutamate receptor antagonist) with a long half-life, which is used for the adjunctive treatment of epilepsy. The literature available identifies a potential for prolonged unconsciousness in overdose. We report a case of prolonged unconsciousness for 14 days following a perampanel overdose of 3.5 times the maximum daily dose, requiring protracted intubation and ventilation on intensive care, with eventual complete neurological recovery. This represents the longest known period of unconsciousness with full recovery and the first reported in a perampanel naïve patient. This case helps to inform decision-making in critical care, particularly the early consideration of admission and intubation. It highlights that while perampanel overdose may not initially cause systemic effects such as cardiac toxicity, it can cause protracted altered consciousness with secondary compromise requiring prolonged intensive care management.

Download Full-text

Pharmacoepidemiology of Furosemide in the Neonatal Intensive Care Unit

Neonatology ◽

10.1159/000510657 ◽

2020 ◽

pp. 1-5

Author(s):

Elizabeth J. Thompson ◽

Daniel K. Benjamin ◽

Rachel G. Greenberg ◽

Karan R. Kumar ◽

Kanecia O. Zimmerman ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Cumulative Dose ◽

Neonatal Intensive Care ◽

Total Duration ◽

Maximum Daily Dose ◽

Daily Dose ◽

Median Cumulative Dose ◽

Short Courses

Background: Furosemide is commonly used off-label in the neonatal intensive care unit (NICU), but current dosing practices vary widely. Objectives: To describe dosing practices including route, dose, and duration of exposure to furosemide in a large number of community and tertiary NICUs across North America. Method: Using the Pediatrix Medical Group Clinical Data Warehouse, we identified infants who received ≥1 dose of furosemide between 1997 and 2016. We excluded infants with incomplete dosing data. We calculated average daily furosemide dose, cumulative dose, total days of exposure, and maximum daily dose. We compared dosing between infants born at <32 weeks gestational age (GA) and ≥32 weeks GA. Results: A total of 18,572 infants had complete dosing data. The median (interquartile value) postnatal age at first exposure was 11 days (4, 26), the median maximum daily dose was 1.0 mg/kg (0.97, 1.6), the median average daily dose was 1.0 mg/kg (0.88, 1.1), and the median cumulative dose was 2.0 mg/kg (1.0, 4.5). The median total duration of exposure was 2 days (1, 4). A total of 177 (1%) infants received ≥4 mg/kg/day of furosemide. Infants born <32 weeks GA were an older age at initial furosemide exposure compared to those born ≥32 weeks GA: 19 versus 4 days, p < 0.001. Conclusions: Most infants received short courses of furosemide within the labeled dosing parameters. Further studies are needed to assess the safety and efficacy of furosemide in the NICU.

Download Full-text

Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit

Medicina Intensiva ◽

10.1016/j.medin.2019.06.008 ◽

2020 ◽

Vol 44 (5) ◽

pp. 294-300 ◽

Cited By ~ 1

Author(s):

J. Vallès ◽

S. Fernández ◽

E. Cortés ◽

A. Morón ◽

E. Fondevilla ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Defined Daily Dose ◽

Treatment Methods ◽

Daily Dose

Download Full-text

A Grave Case of Morphia and Cocaine Habit [Considérations sur un cas grave de morphi-cocaïnomanie]. (Prog. Méd., May 12th, 1900.) Sollier, P

Journal of Mental Science ◽

10.1192/bjp.47.198.603 ◽

1901 ◽

Vol 47 (198) ◽

pp. 603-603

Author(s):

W. C. Sullivan

Keyword(s):

Subcutaneous Tissue ◽

Abdominal Region ◽

Maximum Daily Dose ◽

Daily Dose

The patient was a medical man, æt. 40; the morphia habit dated back ten years, the maximum daily dose being 3 grammes; the cocaine habit was more recent. When the case came under Sollier's treatment the intoxication was profound; the patient was emaciated; there was diffuse induration of the subcutaneous tissue, and there were numerous ulcers in the abdominal region where the patient injected the drugs; the urine contained albumen, and severe uræmic symptoms had appeared; the hæmoglobin was reduced to 4·5 per cent., and was shown by the spectroscope to be very imperfectly oxidised. The author specially indicates this blood-state, as he considers that the symptoms of collapse on the withdrawal of morphia are due to asphyxia.

Download Full-text

Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.713694 ◽

2021 ◽

Vol 8 ◽

Author(s):

Andrea Montisci ◽

Vittorio Palmieri ◽

Jennifer E. Liu ◽

Maria T. Vietri ◽

Silvia Cirri ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Cardiac Toxicity ◽

Cancer Therapies

Graphical Abstract

Download Full-text

Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit

Medicina Intensiva (English Edition) ◽

10.1016/j.medine.2019.06.017 ◽

2020 ◽

Vol 44 (5) ◽

pp. 294-300

Author(s):

J. Vallès ◽

S. Fernández ◽

E. Cortés ◽

A. Morón ◽

E. Fondevilla ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Defined Daily Dose ◽

Treatment Methods ◽

Daily Dose

Download Full-text

Anesthesia and Intensive Care Management in a Pregnant Woman with PRES: A Case Report

Case Reports in Anesthesiology ◽

10.1155/2012/745939 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Ismail Demirel ◽

Ayse Belin Ozer ◽

Mustafa K. Bayar ◽

Salih Burcin Kavak

Keyword(s):

Intensive Care ◽

Pregnant Woman ◽

Visual Impairment ◽

Care Management ◽

Relevant Literature ◽

Immunosuppressive Treatment ◽

Acute Hypertension ◽

Cortical Visual Impairment ◽

The Right ◽

Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a temporary condition that is diagnosed clinically, neurologically, and radiologically. Its symptoms vary, and nonspecific headaches, confusion, impairment of consciousness, nausea, vomiting, and visual impairment may occur. Acute hypertension often accompanies these symptoms. Patients can also suffer from convulsions, cortical visual impairment, and coma. Diagnosis can be difficult due to focal neurologic signs. Nevertheless, knowing the clinical risk factors can lead to the right diagnosis. It has been reported that this condition may also occur during organ transplantation, immunosuppressive treatment, and autoimmune diseases and chemotherapy, and also patients with eclampsia. In this paper, a 21-year-old, 31-week pregnant woman, who had been diagnosed with PRES and thanks to early diagnosis and treatment had fully recovered and discharged from the intensive care unit, is presented, and the relevant literature is discussed.

Download Full-text

A SYSTEMATIC REVIEW OF THERMAL MONITORING TECHNIQUES IN A PEDIATRIC RESUSCITATION AND INTENSIVE CARE UNIT

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-1-35-39 ◽

2020 ◽

Vol 24 (1) ◽

pp. 35-39

Author(s):

Maria A. Berezhnaya ◽

V. G. Amcheslavskiy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Relevant Literature ◽

Evidence Based ◽

Clinical Knowledge ◽

Thermal Monitoring ◽

Intensive Care Unit Staff ◽

Pediatric Resuscitation ◽

Pubmed Database ◽

Based Medicine

This article includes studies which meet the requirements of evidence-based medicine and is written for resuscitation and intensive care unit staff. Articles from PubMed database were used in it. The review of the relevant literature is aimed at practitioners and nurses. These recommendations reflect the current scientific and clinical knowledge base. In everyday practice, the differences and limitations of thermal monitoring and the application of thermoregulatory effects in each individual patient should be taken into account. These recommendations should not be construed as a mandatory protocol of action, and the use of these recommendations does not guarantee a specific clinical outcome. There is no conflict of interest.

Download Full-text

Maximum daily dose of hydrocodone

American Journal of Health-System Pharmacy ◽

10.2146/ajhp100195 ◽

2010 ◽

Vol 67 (19) ◽

pp. 1588-1589 ◽

Cited By ~ 1

Author(s):

Dana M. Nerenberg ◽

Jeffrey Fudin

Keyword(s):

Maximum Daily Dose ◽

Daily Dose

Download Full-text

Dosing of valproate in an elderly population with dementia: Evaluation of discontinuations and dose reductions

Mental Health Clinician ◽

10.9740/mhc.n106822 ◽

2012 ◽

Vol 1 (11) ◽

pp. 274-276

Author(s):

Jonathan G. Leung ◽

Sandra Mullen

Keyword(s):

Elderly Patients ◽

Dose Reduction ◽

Psychiatric Hospitalization ◽

Psychological Symptoms ◽

Functional Decline ◽

Total Daily Dose ◽

Maximum Daily Dose ◽

Daily Dose ◽

Record Review ◽

Initial Starting

It is estimated that more than half of elderly patients with dementia will develop some degree of behavioral and psychological symptoms of dementia (BPSD). BPSD is associated with significant morbidity, rapid functional decline, and psychiatric hospitalization, and there are currently no medications approved by the Food and Drug Administration (FDA) for its treatment. One treatment option that has been evaluated is the antiepileptic drug valproate. This retrospective medical record review evaluated the tolerability of valproate in elderly patients with dementia. A total of 62 patients met inclusion criteria for this review, which sought to determine whether there was an association either between the initial valproate dose and discontinuation or dose reduction (DCDR) or the maximum valproate dose achieved and DCDR. Both the total daily dose and total daily dose in mg/kg were assessed. For both the maximum daily dose (OR 1.0; 95% CI 0.99, 1.01) and maximum daily mg/kg dose (OR =1.15; 95% CI 0.92, 1.49) there was also no association with DCDR. There was no associated risk of DCDR when evaluating initial daily doses (OR: 1.0; 95% CI: 0.99 – 1.01). However, an association between DCDR and initial daily mg/kg dose was found (OR: 1.92; 95% CI: 1.11–4.02). For both the initial dose and initial mg/kg dose model, African Americans were associated with the need for DCDR (OR 20.75; 95% CI: 1.77–660). Results from this study suggest that higher initial starting doses based on weight may lead to higher rates of side effects necessitating a discontinuation or dose reduction; however, large trials are needed to confirm these results.

Download Full-text