Salicylate Intoxication

1997 ◽  
Vol 12 (2) ◽  
pp. 66-78 ◽  
Author(s):  
Luke Yip ◽  
Michael S. Jastremski ◽  
Richard C. Dart
Keyword(s):  
Life Support ◽  
Care Facility ◽  
Health Care Facility ◽  
Poison Control ◽  
Electrolyte Balance ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Salicylate Intoxication ◽  
Base Management

Aspirin (acetylsalicylic acid) is one of the most widely used over-the-counter medications. Because of its availability and widespread use, aspirin has a long history of human toxicity from accidental or intentional overdosing. According to the American Association of Poison Control Centers aspirin was implicated in 19083 exposures in 1995, with 11800 cases treated in a health care facility, and 52 associated deaths. Aspirin toxicity may be a life-threatening condition that produces multiple system organ failure requiring treatment in an intensive care unit. Managing a patient with salicylism will challenge the skills of the critical care team, especially in the areas of life support, fluid and electrolyte balance, and acid-base management. This article reviews the physiology, pathophysiology, acute and chronic salicylism in children and adults, and management of salicylate intoxication.

Pattern of ziprasidone exposures reported to Texas poison centers, 2001–2005

2008 ◽  
Vol 27 (4) ◽  
pp. 355-361 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Age Distribution ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Clinical Effects ◽  
Poison Control Centers ◽  
Poison Centers ◽  
The Mean

Information on potentially adverse exposures to the atypical antipsychotic drug ziprasidone is limited. This study described the pattern of exposures involving only ziprasidone (isolated exposures) reported to Texas poison control centers during 2001–2005. The mean dose was 666 mg. The patient age distribution was ≤5 years (11%), 6–19 years (30%), and ≥20 years (60%). The exposures were intentional in 53% of the cases. Seventy-five percent of the exposures were managed at health care facilities. The final medical outcome was classified as no effect for 39% of the cases and minor effects for 40% of the cases. Adverse clinical effects were listed for 53% of the patients; the most frequently reported being neurological (42%), cardiovascular (13%), and gastrointestinal (5%). The most frequently listed treatment was decontamination by charcoal (34%) or cathartic (28%). Potentially adverse ziprasidone exposures reported to poison control centers are likely to involve management at a health care facility and involve some sort of adverse clinical effect. With proper treatment, the outcomes of such exposures are generally favorable.

Haemophagocytic lymphohistiocytosis secondary to brucellosis in a young child

2021 ◽  
Vol 14 (3) ◽  
pp. e240759
Author(s):  
Jashan Mittal ◽  
Prawin Kumar ◽  
Jagdish Prasad Goyal ◽  
Abhishek Purohit
Keyword(s):  
Haemophagocytic Lymphohistiocytosis ◽  
Appetite Loss ◽  
Specific Therapy ◽  
Adequate Treatment ◽  
Underlying Condition ◽  
Persistent Fever ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication

Brucellosis is a common zoonotic disease worldwide. It has protean clinical manifestation and sometimes may has a life-threatening complication. A 4-year-old boy presented with a history of fever, myalgia and appetite loss for 3 weeks. On examination, he had hepatosplenomegaly. The initial working diagnosis was an infection, autoimmune disease and malignancy. Investigations showed positive Brucella serology, and he was started on rifampicin and cotrimoxazole. He was further investigated because of persistent fever, which revealed evidence of haemophagocytic lymphohistiocytosis (HLH). He continued treatment for brucellosis, except rifampicin which was replaced with doxycyclin due to a worsening liver function. The child showed complete clinical and biochemical improvement after 6 weeks of therapy. HLH is a life-threatening condition and should be suspected in children with brucellosis, who did not respond to appropriate antibiotics treatment. Secondary HLH does not always require specific therapy; it may improve with adequate treatment of the underlying condition.

scholarly journals Non-occlusive mesenteric ischaemia associated with anorexia nervosa

2019 ◽  
Vol 12 (5) ◽  
pp. e229703
Author(s):  
Takashi Sakamoto ◽  
Alan Kawarai Lefor ◽  
Tadao Kubota
Keyword(s):  
Anorexia Nervosa ◽  
Distal Ileum ◽  
Interdisciplinary Management ◽  
Emergency Laparotomy ◽  
Diffuse Peritonitis ◽  
Chronic Haemodialysis ◽  
Mesenteric Ischaemia ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.

scholarly journals Localized Aortic Dissection in a Patient with Polycystic Kidney Disease: A Case Report

2021 ◽  
Vol 6 (04) ◽  
pp. 285-287
Author(s):  
Sarah A. Alkuraydis ◽  
Abdulaziz S. Allihimy ◽  
Osama Smettei ◽  
Rami M Abazid
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Chest Pain ◽  
Uncontrolled Hypertension ◽  
Polycystic Kidney ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Multiple Cysts

Aortic dissection (AD) is the most frequent life-threatening aortic disorder. It is commonly associated with hypertension; however, aortic dissection occasionally represents a complication of more complex syndromes. In this article we aim to report. A 40-year-old male patient, with a known case of ADPKD and a strong family history of ADPKD. He presented to the emergency department with prolonged sharp retrosternal chest pain radiating to the back and uncontrolled hypertension. Computed tomography angiography showed a localized dissection flap at the aortic root and multiple cysts in the right kidney. AD is a life-threatening condition and should be suspected in patients presenting with acute chest pain with history of ADPKD.

scholarly journals A Case of Unilateral Coccidioidal Chorioretinitis in a Patient with HIV-Associated Meningoencephalitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher B. Toomey ◽  
Andrew Gross ◽  
Jeffrey Lee ◽  
Doran B. Spencer
Keyword(s):  
Risk Factors ◽  
Vision Loss ◽  
Complement Fixation ◽  
Rare Condition ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Blurry Vision ◽  
Systemic Symptoms ◽  
The Right

Intraocular coccidioidomycosis is a rare condition, with the most commonly reported presentation being an idiopathic iritis in patients who live in or have traveled thorough endemic areas. A paucity of reports exists describing the chorioretinal manifestations of coccidioidomycosis. Here we report a case of unilateral coccidioidal chorioretinitis and meningoencephalitis in an AIDS patient that led to near complete unilateral loss of vision. A 48-year-old Hispanic female with poorly controlled HIV/AIDS in southern California presented with a three-week history of headache, nausea, vomiting, right eye blurry vision, and a one-day history of subjective fever. Examination of the right eye revealed vitritis and several large chorioretinal lesions scattered throughout the periphery and macula with optic disc pallor. Serum coccidioidomycoses complement fixation (CF) was positive (titers of 1 : 256). Neuroimaging revealed a new area of enhancement in the left anterior frontal lobe consistent with meningoencephalitis. The patient was treated with intravenous fluconazole and intravitreal voriconazole with resolution of systemic symptoms and vitritis but persistence of unilateral, severe chorioretinal scarring and vision loss. In conclusion, in spite of the rarity of intraocular coccidioidomycosis, one must carry a degree of suspicion for this vision- and life-threatening condition as a potential etiology of chorioretinitis in individuals with pertinent risk factors.

Paralysis from an ear infection: a severe case of otitis externa leading to acute complete cervical cord syndrome

2021 ◽  
Vol 14 (12) ◽  
pp. e245594
Author(s):  
Rachael Collins ◽  
George Lafford ◽  
Laura Parry
Keyword(s):  
Otitis Externa ◽  
Severe Case ◽  
Complete Recovery ◽  
Cervical Cord ◽  
Team Approach ◽  
Neck Stiffness ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Red Flag

We report a case of a generally fit and well 54-year-old man who presented with a 2-day history of worsening left-sided otorrhea, headache, neck stiffness, vomiting and fever on the background of a 7-week history of otitis externa (OE). His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery. This case is unique in demonstrating how OE can develop into a potentially life threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of ‘red flag’ symptoms and highlights the importance of a multidisciplinary team approach when managing complex complications of OE.

Vascular calcifications and calciphylaxis in a patient on concurrent haemodialysis and Coumadin therapy

2021 ◽  
Vol 14 (3) ◽  
pp. e240310
Author(s):  
Jack Schnur ◽  
Hadeer Sinawe ◽  
Athina Lidia Yoham ◽  
Damian Casadesus
Keyword(s):  
Pulmonary Oedema ◽  
Wound Care ◽  
Sodium Thiosulfate ◽  
High Morbidity ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Haemodialysis Treatment

Calciphylaxis is a rare life-threatening condition, with calcification of small and medium-sized vessels leading to skin necrosis. It has a high morbidity and mortality, and most of the patients die from wound superinfection and sepsis. A 48-year-old man with a history of end-stage renal disease on haemodialysis and Coumadin therapy for venous thromboembolism presented with pulmonary oedema after missing two haemodialysis treatment. At examination, he had bilateral lower extremity dark brown, possibly necrotic, painful ulcers. He was diagnosed with calciphylaxis and treated with sevelamer hydrochloride, low calcium dialysate and sodium thiosulfate with haemodialysis. He received daily wound care with topical collagenase. After daily wound care treatment for 4 months, the patient’s ulcers completely healed. The patient had been followed for 8 months, which included 29 additional readmissions, 3 admissions related to bacteraemia and 26 admissions with the diagnosis of pulmonary oedema and hyperkalaemia requiring haemodialysis.

Neurological and gastrointestinal symptoms as an initial presentation of pediatric thyroid storm: report of three cases

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Masao Nogami ◽  
Shadia Constantine ◽  
Shuji Sai
Keyword(s):  
Gastrointestinal Symptoms ◽  
Antithyroid Drug ◽  
Severe Case ◽  
Initial Presentation ◽  
Thyroid Storm ◽  
Gi Symptoms ◽  
Old Japanese ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Abstract Objectives Thyroid storm (TS) is a rare but life-threatening condition caused by decompensated hyperthyroidism. There is no consensus on how to diagnose pediatric TS. We report three pediatric cases of TS presenting with central nervous system (CNS) and gastrointestinal (GI) symptoms as the initial presentation of Graves’ disease. Case presentation They were previously healthy adolescents without family history of thyroid disease. CNS symptoms varied from agitation to coma. GI symptoms included abdominal pain, vomiting, and diarrhea. Their laboratory studies revealed thyrotoxicosis and positive result of thyroid-stimulating antibody (TSAb). They were admitted to the intensive care unit (ICU) and received the combination of an antithyroid drug, Lugol’s solution, a beta antagonist, and hydrocortisone. The most severe case was a 13 year-old Japanese girl who presented with loss of consciousness and hemodynamic shock. She died after 5 days of intensive treatment. Conclusions Pediatricians should consider TS in the differential diagnosis when a patient exhibits both CNS and GI symptoms.

Gastropericardial fistula: A rare etiology of chest pain

2017 ◽  
Vol 25 (2) ◽  
pp. 106-109
Author(s):  
Amine Ghalem ◽  
Mehdi Berrajaa ◽  
Kamal Ahsayan ◽  
Mohammed Aabdi ◽  
Imane Boutahar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Wedge Resection ◽  
Unusual Condition ◽  
Gastropericardial Fistula ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Esophagogastric Surgery

Gastropericardial fistula is an abnormal communication between the stomach and the pericardium. It is a rare, life-threatening condition that has numerous etiologies. We report the case of a 53-year-old male patient, with a history of wedge resection for gastrointestinal stromal tumor, who presented to the emergency department for epigastric and chest pain along with lethargy leading to the uncommon diagnosis of gastropericardial fistula with pneumopericardium. Through this case, we would like to draw clinicians’ attention to gastropericardial fistula as a differential diagnosis in patients presenting for epigastric and/or chest pain with a history of esophagogastric surgery, emphasizing on the key role of computed tomography in this regard, and underscore the management basics of this unusual condition.

An 11-year retrospective review of venlafaxine ingestion in children from the California Poison Control System

2015 ◽  
Vol 35 (7) ◽  
pp. 767-774 ◽  
Author(s):  
S Doroudgar ◽  
PJ Perry ◽  
GD Lackey ◽  
NG Veselova ◽  
HM Chuang ◽  
...  
Keyword(s):  
Health Care ◽  
Control System ◽  
Care Facility ◽  
Health Care Facility ◽  
Altered Mental Status ◽  
The United States ◽  
Poison Control ◽  
Minor Effect ◽  
Clinical Effects ◽  
Phone Calls

Venlafaxine is commonly used in the United States for approved and non-Food and Drug Administration–approved indications in adults. It is used off-label to treat children for psychiatric diagnoses. The aim of the study was to describe venlafaxine toxicities in children and to identify the venlafaxine dose per weight that correlates with toxicities. An 11-year retrospective study of venlafaxine ingestion in children was performed using the California Poison Control System (CPCS) database. Data was extracted from phone calls received by CPCS clinicians and follow-up phone calls made to assess the patient’s progress in a health-care setting. Inclusion criteria were venlafaxine ingestion cases reported to CPCS between January 2001 and December 2011, children aged 20 years and under, venlafaxine as the only ingested substance, managed in a health-care facility, and followed to a known outcome. Two hundred sixty-two cases met the study criteria. Common presentations included gastrointestinal (14.9%), altered mental status (13.7%), and tachycardia (13.4%). The majority of the cases resulted in no effect (51.5%) or minor effect (19.9%). The average estimated dose per weight was 18.3 mg/kg in all patients and 64.5 mg/kg in those experiencing moderate-to-severe adverse effects. Seizures occurred in only 4 of the 262 cases at doses ranging from 1500 to 7500 mg. Although the estimated dose per weight exceeded 10 mg/kg for the majority of the cases, only 12 cases resulted in moderate or severe outcomes. The majority of venlafaxine ingestion cases in children resulted in either no clinical effects or minor clinical effects.

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