scholarly journals Eucalyptus oil poisoning: two case reports

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Abraham M. Ittyachen ◽  
Georgie Rajan George ◽  
Meera Radhakrishnan ◽  
Yetin Joy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Supportive Care ◽  
Emergency Room ◽  
Case Reports ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Eucalyptus Oil ◽  
Arterial Blood

Abstract Background Eucalyptus oil poisoning is rare in adults but is not that uncommon in children. The common side effects in children include depression in the level of consciousness, ataxia, seizures, and vomiting. Unlike in children, seizures are unusual in adult patients with eucalyptus oil poisoning. We report the cases of two patients with eucalyptus oil poisoning, both adults who unintentionally took eucalyptus oil and presented to the emergency room of our institution with seizures. Case presentation Two adult Indian men who unintentionally consumed eucalyptus oil presented to the emergency room of our institution with seizures. In both patients, arterial blood gas analysis showed the presence of severe metabolic acidosis. Both the patients were managed in the intensive care unit and received standard supportive care. Metabolic acidosis was corrected with intravenous bicarbonate infusion. They were successfully discharged on the fourth day. Conclusions All physicians should be aware of the toxic effects of eucalyptus oil, which is used often in daily life in India. Supportive care in an intensive care unit, including rapid correction of metabolic acidosis and adequate maintenance of hemodynamic parameters, will lead to a rapid recovery. Warning labels should be made mandatory on all products that contain eucalyptus oil.

scholarly journals Incidental Aluminum Phosphide Poisoning: Case Report and Current Management

Folia Medica ◽  
2018 ◽  
Vol 60 (3) ◽  
pp. 464-467
Author(s):  
Özlem Çakın ◽  
Gokhan Tazegul ◽  
Ayça Gümüş ◽  
Melike Cengiz ◽  
Atilla Ramazanoğlu
Keyword(s):  
Case Report ◽  
Metabolic Acidosis ◽  
Supportive Care ◽  
Case Reports ◽  
Gas Analysis ◽  
Aluminum Phosphide ◽  
Storage Unit ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Local Case

Abstract Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported. Herein, we present a 25-year-old male patient incidentally poisoned with AlP. He was found unconscious in a grain storage unit protected by aluminum phosphide tablets. He had hypotension and tachycardia. Arterial blood gas analysis did not reveal metabolic acidosis. He was quickly intubated and admitted to Intensive Care Unit (ICU). Supportive care crystalloid solution, n-acetyl cysteine and norepinephrine infusion was administered. After 36 hours, he was extubated and discharged without any complications. There is no specific antidote or treatment for AlP toxicity. Literature is controversial regarding treatment approach. Inhalational toxicity may occur under extreme conditions, as presented in this case report. Preventive strategies should be considered to reduce incidents. Clinicians should also be aware that AlP is a widely available and highly toxic compound that has no specific antidote and toxicity needs to be urgently treated with best supportive care.

scholarly journals Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

2020 ◽  
Author(s):  
Lukasz Krzych ◽  
Olga Wojnarowicz ◽  
Paweł Ignacy ◽  
Julia Dorniak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

Reevaluation of the utilization of arterial blood gas analysis in the Intensive Care Unit: Effects on patient safety and patient outcome

2015 ◽  
Vol 30 (2) ◽  
pp. 438.e1-438.e5 ◽  
Author(s):  
Franziska E. Blum ◽  
Elisa Takalo Lund ◽  
Heather A. Hall ◽  
Allan D. Tachauer ◽  
Edgar G. Chedrawy ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Feasıbılıty of Transcutaneous Method for Carbon Dıoxıde Monıtorıng in an Intensive Care Unıt

2022 ◽  
Vol 18 ◽  
Author(s):  
Nazlıhan Boyacı ◽  
Sariyya Mammadova ◽  
Nurgül Naurizbay ◽  
Merve Güleryüz ◽  
Kamil İnci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Partial Pressure ◽  
Blood Gas ◽  
Peripheral Oxygen Saturation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Randomized Controlled Studies ◽  
Significant Difference

Background: Transcutaneous partial pressure of carbon dioxide (PtCO2) monitorization provides a continuous and non-invasive measurement of partial pressure of carbon dioxide (pCO2). In addition, peripheral oxygen saturation (SpO2) can also be measured and followed by this method. However, data regarding the correlation between PtCO2 and arterial pCO2 (PaCO2) measurements acquired from peripheric arterial blood gas is controversial. Objective: We aimed to determine the reliability of PtCO2 with PaCO2 based on its advantages, like non-invasiveness and continuous applicability. Methods: Thirty-five adult patients with hypercapnic respiratory failure admitted to our tertiary medical intensive care unit (ICU) were included. Then we compared PtCO2 and PaCO2 and both SpO2 measurements simultaneously. Thirty measurements from the deltoid zone and 26 measurements from the cheek zone were applied. Results: PtCO2 could not be measured from the deltoid region in 5 (14%) patients. SpO2 and pulse rate could not be detected at 8 (26.7%) of the deltoid zone measurements. Correlation coefficients between PtCO2 and PaCO2 from deltoid and the cheek region were r: 0,915 and r: 0,946 (p = 0,0001). In comparison with the Bland-Altman test, difference in deltoid measurements was -1,38 ± 1,18 mmHg (p = 0.252) and in cheek measurements it was -5,12 ± 0,92 mmHg (p = 0,0001). There was no statistically significant difference between SpO2 measurements in each region. Conclusion: Our results suggest that PtCO2 and SpO2 measurements from the deltoid region are reliable compared to the arterial blood gas analysis in hypercapnic ICU patients. More randomized controlled studies investigating the effects of different measurement areas, hemodynamic parameters, and hemoglobin levels are needed.

scholarly journals Perioperative metabolic acidosis: The Bradford Anaesthetic Department Acidosis Study

2018 ◽  
Vol 20 (1) ◽  
pp. 11-17 ◽  
Author(s):  
TO Lawton ◽  
A Quinn ◽  
SJ Fletcher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Early Phase ◽  
Time Course ◽  
Late Phase ◽  
Common Finding ◽  
Major Surgery ◽  
Arterial Blood ◽  
Early Fluid

Metabolic acidosis is considered deleterious but is common in post-surgical patients admitted to intensive care unit. We evaluated the prevalence and time course of metabolic acidosis in elective major surgery, and generated hypotheses about causes, by hourly arterial blood sampling in 92 patients. Metabolic acidosis began before incision and most had occurred by the next hour. Seventy-eight per cent of patients had a significant metabolic acidosis post-operatively. Two overlapping phases were observed. The early phase started before incision, characterised by a rising chloride and falling anion gap, unrelated to saline use. The late phase was partly associated with lactate, related to surgery type, and early fluids appeared protective. There was a trend towards longer intensive care unit (+1.3 days) and hospital (+3.2 days) stay with metabolic acidosis. This is the first large study of the evolution of this common finding, demonstrating a pre-incision component. The early phase appears unavoidable or unpredictable, but the late phase might be modified by early fluid administration. It remains unclear whether acidosis of this type should be avoided.

scholarly journals Bedside Pulse Oximeters with a Clinical Algorithm Make Economic Sense in the Intensive Care Unit

1996 ◽  
Vol 3 (1) ◽  
pp. 47-51
Author(s):  
David J Leasa ◽  
Jacqueline M Walker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulse Oximeter ◽  
Cost Savings ◽  
Clinical Algorithm ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Before And After ◽  
The Mean ◽  
Pulse Oximeters

OBJECTIVE:To determine the effect on arterial blood gas (ABG) and hospital resource use by introducing a strategy of using bedside oximeters with a clinical algorithm, based on the argument that bedside pulse oximeters make economic sense in the intensive care unit (ICU) if safe patient oxygenation can be ensured at a lower cost than that of existing monitoring options.DESIGN:A before and after design was used to examine the consequences of a pulse oximeter at each bedside in the ICU along with a pulse oximeter clinical algorithm (POCA) describing use for titrating oxygen therapy and for performing ABG analysis.SETTING:A 19-bed multidisciplinary ICU with a six-bed extended ICU (EICU) available to function as a 'step-down' facility.PATIENTS:All patients admitted to the ICU/EICU over two 12-month periods were included.RESULTS:The strategy yielded a 31% reduction in the mean number of ABGs per patient after POCA (20.0±26.1 versus 13.8±16.7, mean ± SD; P<0.001) as well as a potential annual cost savings of $32,831.CONCLUSIONS:Bedside oximeters within the ICU, when used with explicit guidelines, reduce ABG use and result in hospital cost savings.

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