scholarly journals Multimodal Elimination for Intoxication with a Lethal Dose of Organic Mercury

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
L. C. Napp ◽  
C. Moelgen ◽  
F. Wegner ◽  
P. Heitland ◽  
H. D. Koester ◽  
...  
Keyword(s):  
Multiorgan Failure ◽  
Lethal Dose ◽  
Chelating Agent ◽  
Organ Damage ◽  
Refractory Status Epilepticus ◽  
Organ Support ◽  
Organic Mercury ◽  
Refractory Status ◽  
Mercury Intoxication ◽  
High Doses

We here report on a case of massive organic mercury intoxication in a 40-year-old man that resulted in progressive multiorgan failure. We treated the patient intravenously and enterally with the chelating agent (RS)-2,3-bis(sulfanyl) propane-1-sulfonic acid (DMPS) in addition to hemodialysis. The patient was treated for 6 weeks and could successfully be weaned from mechanical ventilation and hemodialysis. He awoke and was sent to rehabilitation, but unfortunately died 7 months later from refractory status epilepticus. Autopsy revealed severe brain atrophy consistent with organ damage from massive mercury intoxication. The present case illustrates that bimodal DMPS application is sufficient for detoxification from lethal mercury levels, with an associated chance for weaning of organ support and survival to discharge. The case further reminds us of intoxication as a cause of multiorgan dysfunction. We propose to immediately initiate combined parenteral and enteral detoxification in cases of methyl mercury intoxication, especially in cases of high doses.

scholarly journals Management of Status Epilepticus

2019 ◽  
Vol 06 (03) ◽  
pp. 267-274
Author(s):  
Ritesh Lamsal ◽  
Navindra R. Bista
Keyword(s):  
Status Epilepticus ◽  
High Risk ◽  
Critically Ill Patients ◽  
Initial Treatment ◽  
Refractory Status Epilepticus ◽  
The Past ◽  
Anesthetic Agents ◽  
Refractory Status ◽  
Life Threatening ◽  
High Doses

AbstractStatus epilepticus (SE) is a life-threatening neurologic condition that requires immediate assessment and intervention. Over the past few decades, the duration of seizure required to define status epilepticus has shortened, reflecting the need to start therapy without the slightest delay. The focus of this review is on the management of convulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment of both forms of status epilepticus includes immediate assessment and stabilization, and administration of rapidly acting benzodiazepine therapy followed by nonbenzodiazepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and SRSE) pose a lot of therapeutic problems, necessitating the administration of continuous infusion of high doses of anesthetic agents, and carry a high risk of debilitating morbidity as well as mortality.

Cannabidiol as a Potential Treatment for Febrile Infection-Related Epilepsy Syndrome (FIRES) in the Acute and Chronic Phases

2016 ◽  
Vol 32 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Jacqueline S. Gofshteyn ◽  
Angus Wilfong ◽  
Orrin Devinsky ◽  
Judith Bluvstein ◽  
Joshi Charuta ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Multiorgan Failure ◽  
Case Series ◽  
Chronic Phase ◽  
Febrile Illness ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Open Label ◽  
Normal Children ◽  
Refractory Status

Febrile infection-related epilepsy syndrome (FIRES) is a devastating epilepsy affecting normal children after a febrile illness. FIRES presents with an acute phase with super-refractory status epilepticus and all patients progress to a chronic phase with persistent refractory epilepsy. The typical outcome is severe encephalopathy or death. The authors present 7 children from 5 centers with FIRES who had not responded to antiepileptic drugs or other therapies who were given cannabadiol (Epidiolex, GW Pharma) on emergency or expanded investigational protocols in either the acute or chronic phase of illness. After starting cannabidiol, 6 of 7 patients’ seizures improved in frequency and duration. One patient died due to multiorgan failure secondary to isoflourane. An average of 4 antiepileptic drugs were weaned. Currently 5 subjects are ambulatory, 1 walks with assistance, and 4 are verbal. While this is an open-label case series, the authors add cannabidiol as a possible treatment for FIRES.

scholarly journals Oral Perampanel for the Treatment of Super-Refractory Status Epilepticus

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Abdallah Rahbani ◽  
Grace Adwane ◽  
Najo Jomaa
Keyword(s):  
Valproic Acid ◽  
Status Epilepticus ◽  
Clinical Outcome ◽  
Nasogastric Tube ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
Partial Status Epilepticus ◽  
High Doses ◽  
Excellent Clinical Outcome ◽  
Partial Status

A 72-year-old man presented with a super-refractory partial status epilepticus following evacuation of a right subdural hematoma. He failed to respond to treatment with high doses of intravenous valproic acid, Levetiracetam, Lacosamide, Thiopental, and Midazolam. He was given 4 mg of Perampanel orally via nasogastric tube and the dose was rapidly increased to 8 mg after 12 hours with cessation of clinical and electrical seizures. Other antiepileptic drugs were tapered progressively with an excellent clinical outcome.

scholarly journals New-Onset Refractory Status Epilepticus: More Investigations, More Questions

2016 ◽  
Vol 8 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Philippe Dillien ◽  
Susana Ferrao Santos ◽  
Vincent van Pesch ◽  
Vanessa Suin ◽  
Sophie Lamoral ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Immune Therapy ◽  
Healthy Woman ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
The Status ◽  
Third Line Therapy ◽  
High Doses ◽  
Third Line ◽  
New Onset

A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA) technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.

Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

2021 ◽  
pp. 1-10
Author(s):  
Guglielmo Consales ◽  
Lucia Zamidei ◽  
Franco Turani ◽  
Diego Atzeni ◽  
Paolo Isoni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Multiorgan Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Kidney Injury ◽  
Protective Ventilation ◽  
Retrospective Observational Study ◽  
Organ Support ◽  
Chronic Obstructive

<b><i>Background:</i></b> Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO<sub>2</sub> with very low extracorporeal blood flows (&#x3c;400 mL/min). <b><i>Objectives:</i></b> To evaluate efficacy and safety of combined ECCO<sub>2</sub>R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. <b><i>Methods:</i></b> We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO<sub>2</sub>R-CRRT were recorded. <b><i>Results:</i></b> Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO<sub>2</sub> clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. <b><i>Conclusion:</i></b> ECCO<sub>2</sub>R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

scholarly journals How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

2021 ◽  
pp. 153575972199832
Author(s):  
Karnig Kazazian ◽  
Marissa Kellogg ◽  
Nora Wong ◽  
Krista Eschbach ◽  
Raquel Farias Moeller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Neurologic Disorder ◽  
Mortality And Morbidity ◽  
Refractory Status ◽  
Rigorous Research ◽  
Active Epilepsy ◽  
New Onset

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

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