scholarly journals Acute poisoning with acetamiprid: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Selladurai Pirasath ◽  
Rajaram Senthuran ◽  
Chandrakulasegeran Athirayan ◽  
Mathyasekeran Gevakaran ◽  
Mahesan Guruparan ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Blood Pressure Monitoring ◽  
Ventilatory Support ◽  
Clinical Manifestations ◽  
Supportive Therapy ◽  
Agricultural Practices ◽  
Acute Poisoning ◽  
Middle Aged ◽  
Severe Nausea ◽  
Altered Level

Abstract Background Acetamiprid is a potent new first-generation neonicotinoid insecticide in agricultural practices. It is well described that it has low toxicity among animals and is lethal if consumed in large amounts. However, toxicity in humans is rarely reported in literature. Here, we describe acetamiprid toxicity complicated with severe lactic acidosis, myocardial ischemia, refractory hypotension, and severe hypokalemia in a middle-aged man who presented with deliberate self-harming with acetamiprid poisoning in Sri Lanka. Case presentation We describe a case of acute poisoning with an acetamiprid in a middle-aged Sri Lankan Tamil farmer for suicidal purposes following family conflicts with his wife. He presented with severe nausea, vomiting, and altered level of consciousness. He had electrocardiogram changes, hypoxia, and lactic acidosis. With intensive care management including ventilatory support, inotropic therapy along with intraarterial blood pressure monitoring, correction of acidosis, and administration of electrolytes, he made good clinical recovery. He was discharged without any further complications 6 days after ingestion of acetamiprid. Conclusions This case illustrates a rare, acute poisoning with acetamiprid in human, as well as its clinical manifestations and successful management with supportive therapy. This will be helpful for clinicians to identify clinical manifestations and to guide management of acute poisoning with acetamiprid in the future.

Carbon monoxide: mechanism of toxic action, pathogenesis and clinical manifestations of acute intoxication

2021 ◽  
pp. 4-9
Author(s):  
A. N. Grebenyuk ◽  
V. N. Bykov
Keyword(s):  
Carbon Monoxide ◽  
Clinical Manifestations ◽  
Acute Poisoning ◽  
Toxic Action ◽  
Acute Intoxication ◽  
Emergency Situations ◽  
Common Causes ◽  
The Central Nervous System ◽  
Regulatory Effects ◽  
Mitochondrial Cytochrome Oxidase

Introduction. Carbon monoxide (CO) remains one of the most common causes of acute poisoning and death, both in everyday life and in emergency situations, especially in fires.Material and methods. The paper summarizes information about the regulatory effects, mechanisms of toxic action, pathogenesis and clinical picture of intoxication, as well as predictors of the severity of CO poisoning.Results. The main mechanism of the toxic effect of CO is due to its ability to bind to the protohemal iron of hemoglobin (Hb) to form carboxyhemoglobin (HbCO). The toxicity of CO may also be enhanced by impaired functions of the myoglobin of the myocardium and skeletal muscles, mitochondrial cytochrome oxidase, and iron-containing enzymes of the antioxidant system. The leading link in the pathogenesis of acute CO intoxication is a violation of the oxygen transport function of hemoglobin and the associated development of hemic and tissue hypoxia. CO-induced cell and tissue damage due to the induction of mitochondrial dysfunction, oxidative stress, free radical hyperproduction, lipid peroxidation, inflammation, and apoptosis also play a role in the pathogenesis of intoxication.Conclusion. The mechanism of toxic action of CO, associated primarily with the formation of carboxyhemoglobin and the development of hypoxia, determines the clinical manifestations of acute intoxication, which depend on the concentration of CO and the duration of exposure, but are almost always associated with the central nervous system and cardiovascular system.

scholarly journals Fat Embolism and Nonconvulsive Status Epilepticus

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yanetsy Olivera Arencibia ◽  
Mai Vo ◽  
Jennifer Kinaga ◽  
Jorge Uribe ◽  
Gloria Velasquez ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Supportive Therapy ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Nonconvulsive Status Epilepticus ◽  
Altered Level ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Wide Range

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Ambulatory blood pressure monitoring changes in hypertensive patients

2019 ◽  
Vol 2 (8) ◽  
pp. 53-57
Author(s):  
V.S. Pasko
Keyword(s):  
Blood Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Middle Aged ◽  
Hypertensive Patients

The aim of the study was to determine the peculiarities of ABPM indices in middle-aged and elderly hypertensive patients depending on the daily BP profile. Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. The control group consisted of 15 patients for every of the surveyed categories (group III - middle-aged and group IV – elderly respectively) matched with basic by age and gender. Results. We have shown that one of the factors that determines the change in hemodynamics in patients with essential hypertension is age, with the age patients experience the decrease in diastolic blood pressure with steadily increased systolic blood pressure, that should be considered in the prescription of antihypertensive treatment. With age, a gradual increase in systolic blood pressure is associated with the increased aortic stiffness, partially with the increase in collagen and the decrease in elastic fibrils and the formation of isolated systolic hypertension. Thus, it is proved that in the formation of isolated hypertension the growth of pulse blood pressure for more than 60 mm Hg is unfavorable in a development of cerebrovascular events. Pulse arterial blood pressure was stronger risk factor than systolic blood pressure and diastolic blood pressure or average arterial pressure in the elderly. Recently, taking into account age characteristics, all three indices were recognized as comparable predictors at the age of 50-59 years as the transitional period, and at the age of 60-79 years diastolic blood pressure adversely affecting the cardiovascular risk, increased pulse blood pressure prognostically above the level of systolic arterial pressure.

scholarly journals ALOX5 , LPA , MMP9 and TPO gene polymorphisms increase atherothrombosis susceptibility in middle-aged Mexicans

2020 ◽  
Vol 7 (1) ◽  
pp. 190775
Author(s):  
Rafael Camacho-Mejorado ◽  
Rocío Gómez ◽  
Luisa E. Torres-Sánchez ◽  
Esther Alhelí Hernández-Tobías ◽  
Gino Noris ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Native Americans ◽  
Gene Polymorphisms ◽  
Clinical Manifestations ◽  
Cross Sectional Study ◽  
Middle Aged ◽  
Cross Sectional ◽  
Healthy Group ◽  
And Gender ◽  
And Oxidative Stress

Atherothrombosis is the cornerstone of cardiovascular diseases and the primary cause of death worldwide. Genetic contribution to disturbances in lipid metabolism, coagulation, inflammation and oxidative stress increase the susceptibility to its development and progression. Given its multifactorial nature, the multiloci studies have been proposed as potential predictors of susceptibility. A cross-sectional study was conducted to explore the contribution of nine genes involved in oxidative stress, inflammatory and thrombotic processes in 204 subjects with atherothrombosis matched by age and gender with a healthy group ( n = 204). To evaluate the possibility of spurious associations owing to the Mexican population genetic heterogeneity as well as its ancestral origins, 300 unrelated mestizo individuals and 329 Native Americans were also included. ALOX5 , LPA , MMP9 and TPO gene polymorphisms, as well as their multiallelic combinations, were twice to four times more frequent in those individuals with clinical manifestations of atherothrombosis than in the healthy group. Once adjusting for population stratification was done, these differences remained. Our results add further evidence on the contribution of ALOX5 , LPA , MMP9 and TPO polymorphisms to atherothrombosis development in the middle-aged group, emphasizing the multiethnic studies in search of gene risk polymorphisms.

Multicenter Phase II Trial of Patients with Refractory or Recurrent Multiple Myeloma with Oral Treatment of Thalidomide Combined with Oral Cyclophosphamide, Idarubicin and Dexamethasone.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4825-4825
Author(s):  
Axel Glasmacher ◽  
Thomas Moehler ◽  
Hartmut Goldschmidt ◽  
Thomas Geer ◽  
Rolf Kleinschmidt ◽  
...  
Keyword(s):  
Remission Rate ◽  
Oral Treatment ◽  
Supportive Therapy ◽  
Response To Treatment ◽  
High Dose ◽  
Hematologic Toxicity ◽  
Induction Phase ◽  
Standard Chemotherapy ◽  
Severe Nausea ◽  
Cycle Number

Abstract Introduction and rationale: The aim of our study is to evaluate the role of thalidomide in combination with oral CID therapy in order to improve treatment wit an all oral regime. Patients and methods: Patients with refractory or relapsed myeloma were included into this trial. Concerning inclusion criteria, 10 patients had progressive disease after standard chemotherapy, 12 no change after standard chemotherapy and required further therapy, 6 recurrent disease after standard therapy and 22 recurrence after high dose chemotherapy. At start of the treatment patients were in stages IIA (16 patients), IIB (1), IIIA (34) and IIIB (1). Idarubicin was given in capsules at 8–10 mg/m2/day for days 1–4, 40 mg dexamethasone were given on days 1–4 and 15–18, cyclophosphamide at 200 mg/m2/d d1–4 and thalidomide 100mg daily with scheduled increase to 400mg. Treatment cycles were repeated every 28 days. 3–8 cycles were applied. Supportive therapy consisted of PEG-filgrastim, cotrimoxazol, dalteparin and ibandronate. In addition, after the induction phase patients were randomized between thalidomide and thalidomide / idarubicin maintenance treatment. Results: At this interim analysis, 66 patients have been entered into the ongoing trial; 6 patients had to be excluded for violation of unclusion criteria. Of the 60 included patients, 52 patients have been documented so far and are evaluable for toxicity. In total, 187 cycles have been applied. Median cycle number was 3 (1–8). There was one death during treatment due to progressive myeloma at cycle 1. The median age was 62 years (interquartile range 57–67). The following toxicities were observed: FUO (2 patients), pneumonia (4), pulmonary embolism (1), exsiccosis after diarrhea (1), constipation (1), sepsis (1), severe nausea (2), syncope (1), collaps after bleeding (1, not related to TCID treatment) and mucositis grade 4 (1). Hematologic toxicity grade IV was reported in 35% of the patients, mainly in cycles 1 and 2. Concerning response to treatment 41 patients are evaluable for response so far. Of these 31 (76%) achieved a PR (24 patients) or MR (7 patients) according to EBMT criteria, 4 patients a stable disease and 3 patients a PD. Three patients were not evaluable and scorded as failures. Conclusions: T-CID is feasible and highly effective in relapsed or refractory myeloma patients. Toxicity seems to be acceptable and mainly hematologic and infectiologic. The remission rate of 76% is encouraging.

Macroangiopathy in type II diabetes

1983 ◽  
Vol 104 (4_Suppl) ◽  
pp. S75-S78
Author(s):  
Antti Aro
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Type Ii Diabetes ◽  
Clinical Manifestations ◽  
Diabetic Patients ◽  
Type Ii ◽  
Peripheral Vascular ◽  
Middle Aged

ABSTRACT. Macroangiopathy is the most important cause of mortality and morbidity in type II diabetes. The atherosclerotic process in diabetes is similar to that found in non-diabetic subjects, but the laesions are more extensive and the clinical manifestations are more common in diabetic subjects than in the non-diabetic population. In diabetic patients from different populations, the prevalence of macroangiopathy is variable, and the relative frequency follows the pattern found in the respective non-diabetic populations. The relative risk of large vessel disease is in most populations higher for female than for male diabetics. Coronary heart disease is the most important manifestation of macroangiopathy while cerebrovascular disease and peripheral vascular disease are less frequent, although all these manifestations occur at increased frequency among middle-aged diabetic subjects. The incidence of peripheral vascular disease seems to increase with increasing duration of diabetes in middle-aged subjects, whereas coronary heart disease is particularly frequent in type II diabetes already at the time of the diagnosis. Key words: atherosclerosis, complications, diabetes mellitus, macroangiopathy, mortality.

Characteristics and demographics of reversible cerebral vasoconstriction syndrome: A large prospective series of Korean patients

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 765-775 ◽  
Author(s):  
Hyun Ah Choi ◽  
Mi Ji Lee ◽  
Hanna Choi ◽  
Chin-Sang Chung
Keyword(s):  
Medical Center ◽  
Clinical Manifestations ◽  
Neurological Complications ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Middle Aged ◽  
Cerebral Vasoconstriction ◽  
Female Predominance ◽  
Predominantly Female ◽  
Preceding Event

Objectives To report demographics and characteristics of reversible cerebral vasoconstriction syndrome (RCVS) in the Korean cohort. Methods We prospectively recruited patients with definite (imaging-proven) RCVS and probable (imaging-negative) RCVS who visited Samsung Medical Center between June 2012 and September 2016. Clinical manifestations, neuroimaging, treatment, and clinical outcomes were evaluated in all patients. Characteristics of RCVS without typical causes (“idiopathic RCVS”) were compared with those of RCVS with identifiable causes (“secondary RCVS”). International Classification of Headache Disorders (ICHD)-3 beta criteria for 6.7.3 RCVS and 6.7.3.1 probable RCVS were tested. Results A total of 138 patients (104 definite and 34 probable RCVS) were included in this study. Patients with definite RCVS were predominantly female (85.6%) and middle-aged (mean, 50.7 [range, 23–82] years). Probable RCVS was associated with less female predominance (70.6%, p = 0.049), more typical manifestations ( p < 0.001), and none of neurological complications. One-hundred and one (97.1%) patients with definite RCVS had headache, but the typical “recurrent and/or triggered” thunderclap headache was reported in only 83 (82.2%). In most patients with definite RCVS (84.6%), RCVS was idiopathic, while only 16 (15.4%) had secondary causes. Compared to those with secondary RCVS, patients with idiopathic RCVS were older (52.8 ± 11.42 vs. 39.1 ± 9.55 years, p < 0.001). Patients with secondary RCVS had more complications than those with idiopathic RCVS (40.5% vs. 12.5%, p = 0.018). Among idiopathic RCVS patients, 33 (37.5%) reported a preceding event or a change in lifestyle, environment, health, or medication within one month before onset. Conclusion In our cohort, RCVS was benign and idiopathic in most patients, and occurred frequently in middle-aged women. Manifestations of RCVS were more diverse than previously recognized, and forms without any headache existed. Different genetic, social, and environmental factors should be taken into account to unveil the spectrum and pathophysiology of RCVS.

scholarly journals TUBERCULOSTATICS ACUTE POISONING: DIAGNOSTIC AND TREATMENT

2015 ◽  
Vol 64 (3) ◽  
pp. 277-281
Author(s):  
Dora Andreea Boghitoiu ◽  
◽  
Coriolan Emil Ulmeanu ◽  
◽  
◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Medical History ◽  
Vitamin B6 ◽  
Clinical Manifestations ◽  
Gastric Fluid ◽  
Acute Poisoning ◽  
Emergency Admissions ◽  
Verbal Stimuli ◽  
Generalized Seizures ◽  
Life Threatening

Introduction. Although the frequency of isoniazid poisoning is not very high, there are life threatening conditions which require a swift diagnosis and treatment. Material and method. We present the case of a female patient, aged 15 admitted in our clinic, by means of transfer, from another medical unit, due to tonic-clonic generalized seizures, followed by emesis and coma. The patient arrived at the Emergency Admissions Unit of our hospital, in coma, Glasgow 8, orotracheally intubated. She did not respond to verbal stimuli, but she did respond to deep, painful stimuli with marked agitation. The patient has a nasogastric tube, on which an orange liquid is visible on the outside and on the urinary catheter – orange colored urine. From the patient’s medical history, which was obtained from the patient’s mother, we noticed that the patient had been, for the past 4 months, under treatment with tuberculostatic drugs (Isoniazid, Rifampicin and vitamin B6). The patient administered the medication herself. Results. Based on clinical manifestations, i.e. tonic-clonic generalized seizures, incoercible emesis and coma, reddish-orange color of the gastric fluid and urine, at over 6 hours after the onset, on the patient’s medical history and based on laboratory results which revealed metabolic acidosis the suspicion of acute tuberculo-static poisoning arose. We started antidotal therapy with vitamin B6 with favorable clinical evolution. Conclusion. Acute isoniazid poisoning must be suspected in the case of any patient who presents the classic triad: refractory seizures, severe metabolic acidosis and coma and the treatment with the specific antidote-pyridoxine, must be available at any emergency unit.

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