Basic toxicological approach has been effective in two poisoned patients with amitraz ingestion: case reports

2002 ◽  
Vol 21 (1) ◽  
pp. 55-57 ◽  
Author(s):  
Z Doganay ◽  
D Aygun ◽  
L Altintop ◽  
H Guven ◽  
F Bildik
Keyword(s):  
Mechanical Ventilation ◽  
Adrenergic Receptors ◽  
Case Reports ◽  
Gastric Lavage ◽  
Clinical Findings ◽  
Pharmacological Effects ◽  
Laboratory Findings ◽  
Basic Approach ◽  
Life Threatening ◽  
Supportive Management

Amitraz, a formamidine insecticide and acaricide used in veterinary practice, presents side effects in humans related to its pharmacological activity on alpha 2-adrenergic receptors. There is little information available in the literature about the toxicology of the product in man and the treatment of this poisoning. In this report, the clinical and laboratory features of amitraz poisoning in two patients by a veterinary formulation also containing xylene are presented. The major clinical findings were unconsciousness, drowsiness, respiratory failure requiring mechanical ventilation, miosis, hypothermia and brady cardia. The laboratory findings were hyperglycemia, hypertransaminasemia and increased urinary output. Supportive management of this poisoning in humans is suggested in only a few articles and there is no specific antidote for the subsequent possible pharmacological effects of amitraz. In our two cases, we performed supportive treatment such as mechanical ventilation, atropine, gastric lavage, active carbon, oxygen and fluid administration. We concluded that the basic approach to the patient with amitraz poisoning, including initial stabilization to correct immediate life-threatening problems, treatment to reduce absorption and measures to improve elimination of the toxin, is effective.

scholarly journals SARS-COV-2 transmission among family members

2020 ◽  
Vol 26 (3) ◽  
pp. 143-148
Author(s):  
Gordana Todorović ◽  
Aleksandar Joldžić ◽  
Slađana Anđelić ◽  
Darko Nedeljković
Keyword(s):  
Case Reports ◽  
Family Members ◽  
Clinical Findings ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Indirect Contact ◽  
Protein Levels ◽  
The World ◽  
High Erythrocyte Sedimentation Rate ◽  
Loss Of Appetite

Introduction/Objective Severe acute respiratory distress syndrome caused by coronavirus 2 (SARS-COV-2) is a new respiratory disease -COVID-19. A virus from the Coronaviridae family, highly contagious and virulent took over the world in a very short time causing the 2019/2020 pandemic. We are presenting the case of COVID-19 transmission among family members, patients of various ages, sex, clinical presentation and findings, who have been infected in different ways. Case reports Three patients are described, all with different coronavirus-specific symptomatology. Symptoms ranged from fatigue and loss of appetite with no other, more prominent symptoms in the youngest patient, to fever, high temperature, diarrhoea, muscle ache and chest pain during inspiration in the oldest patient. The third patient's dominant symptoms were dry, non-productive cough, lack of oxygen, shortness of breath and perspiration on exertion, headache and normal temperature, with radiographically confirmed bilateral pneumonia. Laboratory findings (leukopenia, lymphocytopenia with elevated C-reactive protein levels, high erythrocyte sedimentation rate and lactate dehydrogenase levels) were consistent with a viral infection, highly suspicious of SARS-COV-2, which was confirmed with a real-time RT-PCR test in all three patients. After being hospitalized in the Clinical Hospital Center "Zemun" Department of Pulmonology and treated with symptomatic, antiviral and antibiotic therapy, the disease regressed and the RT-PCR tests became negative. Conclusion SARS-COV-2 is a very aggressive and potent cause of the coronavirus disease. The presented cases confirm the possibility of quick transmission within a family through direct and indirect contact, as well as the diversity of symptoms, laboratory and clinical findings. Our clinical examples are similar in symptomatology and available results to cases from other parts of the world hit with the pandemic.

scholarly journals Low-dose intravenous lipid emulsion for the treatment of severe quetiapine and citalopram poisoning

2016 ◽  
Vol 67 (2) ◽  
pp. 164-166 ◽  
Author(s):  
Darinka Purg ◽  
Andrej Markota ◽  
Damjan Grenc ◽  
Andreja Sinkovič
Keyword(s):  
Mechanical Ventilation ◽  
Lipid Emulsion ◽  
Low Dose ◽  
Case Reports ◽  
Dose Range ◽  
Gastric Lavage ◽  
Heart Rhythm ◽  
Psychiatric Ward ◽  
Intravenous Lipid Emulsion ◽  
Caucasian Girl

AbstractThe treatment of quetiapine and/or citalopram poisoning is mainly supportive and involves gastric lavage, activated charcoal, intubation, and mechanical ventilation. Recently, however, there were reports of successful treatment with intravenous lipid emulsion. Here we report a case of a 19-year-old Caucasian girl who ingested approximately 6000 mg of quetiapine, 400 mg of citalopram, and 45 mg of bromazepam in a suicide attempt. The patient developed ventricular tachycardia and epileptic seizures 12 h after admission to the hospital. As the patient’s condition deteriorated, we combined standard therapy (intubation, mechanical ventilation, and vasopressors) with low-dose intravenous lipid emulsion (ILE) (a total of 300 mL of 20 % lipid emulsion) and normalised her heart rhythm and stopped the seizures. She was discharged to the psychiatric ward after 48 h and home after a prolonged (2-month) psychiatric rehabilitation. Intravenous lipid emulsion turned out to be effective even in the lower dose range than previously reported for quetiapine poisoning in patients presenting with seizure and ventricular arrhythmia. To our knowledge, there are no case reports describing the use of ILE in treating citalopram poisoning.

A Case Report on Methimazole Induced Anti-Thyroid Arthritis Syndrome: A Rare Drug Induced Migratory Polyarthritis

2021 ◽  
pp. 5483-5488
Author(s):  
Aiswarya Mohan ◽  
Aravind H ◽  
Chakravarthy S Maddipati ◽  
Roshni P R
Keyword(s):  
Adverse Effect ◽  
Case Reports ◽  
Antithyroid Drugs ◽  
Drug Discontinuation ◽  
Graves Disease ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Diagnosis And Management ◽  
Life Threatening ◽  
Migratory Polyarthritis

Antithyroid drugs (ATD’s) are widely used as the first line treatment option for the management of hyperthyroidism, especially for patients with Graves’ disease. They are classified into thionamide (Methimazole, Carbimazole and Propylthiouracil) and Non-thionamide (Iodine containing compounds) ATD’s. These drugs are associated with various types of adverse effects ranging from mild to potentially life threatening. Antithyroid arthritis syndome (AAS) is one of the major and uncommon side effects of ATD therapy requiring immediate drug discontinuation and hospitalization presents itself with myalgia, arthralgia and arthritis along with fever and rash of varying severity and non-specific laboratory findings, making its diagnosis and management clinically challenging. Here we report the case of 32 year old female with Graves’ disease who experienced severe migratory polyarthritis after the initiation of methimazole therapy. Her symptoms started to disappear after the prompt withdrawal of methimazole. We also concluded that this adverse effect of ATD’s might not be dose dependent by comparing our case with 6 other case reports of AAS. Here our objective is to raise awareness among the clinicians regarding the differential diagnosis and management of this major, uncommon and potentially life threatening adverse effect of ATD therapy.

Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

1996 ◽  
Vol 35 (04) ◽  
pp. 116-121 ◽  
Author(s):  
G. E Fueger ◽  
M. Vejda ◽  
R. M. Aigner
Keyword(s):  
Bone Scintigraphy ◽  
Antibiotic Treatment ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Serum Parameters ◽  
Wbc Count ◽  
Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

scholarly journals An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings

2013 ◽  
Vol 47 (2) ◽  
pp. 125-127
Author(s):  
Hakan Önder ◽  
Faysal Ekici ◽  
Emin Adin ◽  
Suzan Kuday ◽  
Hatice Gümüş ◽  
...  
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Magnetic Resonance ◽  
Biliary Obstruction ◽  
Fasciola Hepatica ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical Findings ◽  
Imaging Studies ◽  
Laboratory Findings ◽  
Acoustic Shadow

Background. Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

scholarly journals Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

2020 ◽  
Vol 13 (2) ◽  
pp. e231995
Author(s):  
Brittany Sanford ◽  
Catherine Hoeppner ◽  
Tammy Ju ◽  
Brian K Theisen ◽  
Anna BuAbbud ◽  
...  
Keyword(s):  
General Surgery ◽  
Case Reports ◽  
Hepatocellular Adenoma ◽  
Multidisciplinary Care ◽  
Exploratory Laparotomy ◽  
Pregnant Patient ◽  
Haemorrhagic Shock ◽  
Liver Adenoma ◽  
Life Threatening ◽  
Temporary Closure

Management of a ruptured hepatocellular adenoma during pregnancy is a rare and potentially life-threatening entity. Few case reports have described management of the pregnant patient who presents in haemorrhagic shock secondary to a ruptured liver adenoma. A 30-year-old primigravid woman at 31 weeks pregnant presented with abdominal pain and fetal bradycardia. After stat caesarean delivery of the infant, she had continued hemoperitoneum and was in shock secondary to an undiagnosed ruptured liver mass. General surgery was consulted intraoperatively and performed an exploratory laparotomy, packing and temporary closure. She was subsequently taken to interventional radiology (IR) for angioembolisation of the left hepatic artery. After stabilisation, she underwent formal abdominal closure. Management of a ruptured hepatocellular adenoma in pregnancy requires urgent multidisciplinary care including obstetrics gynaecology, general surgery and IR.

scholarly journals The Relationship between Inflammatory Cytokines and Coagulopathy in Patients with COVID-19

2021 ◽  
Vol 10 (9) ◽  
pp. 2020
Author(s):  
Fariba Rad ◽  
Ali Dabbagh ◽  
Akbar Dorgalaleh ◽  
Arijit Biswas
Keyword(s):  
Inflammatory Cytokines ◽  
Interleukin 1 ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Necrosis Factor Alpha ◽  
Coagulation Parameters ◽  
Increased Risk ◽  
Cytokine Levels ◽  
Α Level ◽  
High Level

Coronavirus disease 2019 (COVID-19), with a broad range of clinical and laboratory findings, is currently the most prevalent medical challenge worldwide. In this disease, hypercoagulability and hyperinflammation, two common features, are accompanied by a higher rate of morbidity and mortality. We assessed the association between baseline inflammatory cytokine levels and coagulopathy and disease outcome in COVID-19. One hundred and thirty-seven consecutive patients hospitalized with COVID-19 were selected for the study. Baseline interleukin-1 (IL-1), IL-6, and tumor necrosis factor alpha (TNF-α) level were measured at time of admission. At the same time, baseline coagulation parameters were also assessed during the patient’s hospitalization. Clinical findings, including development of thrombosis and clinical outcome, were recorded prospectively. Out of 136 patients, 87 (~64%) had increased cytokine levels (one or more cytokines) or abnormal coagulation parameters. Among them, 58 (~67%) had only increased inflammatory cytokines, 12 (~14%) had only coagulation abnormalities, and 17 (19.5%) had concomitant abnormalities in both systems. It seems that a high level of inflammatory cytokines at admission points to an increased risk of developing coagulopathy, thrombotic events, even death, over the course of COVID-19. Early measurement of these cytokines, and timely co-administration of anti-inflammatories with anticoagulants could decrease thrombotic events and related fatal consequences.

Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children

2003 ◽  
Vol 22 (12) ◽  
pp. 665-668 ◽  
Author(s):  
Hüseyin Çaksen ◽  
Dursun Odabaş ◽  
Sinan Akbayram ◽  
Yaşar Cesur ◽  
Şükrü Arslan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Signs And Symptoms ◽  
Atropa Belladonna ◽  
Laboratory Findings ◽  
Severe Intoxication ◽  
Symptoms And Signs

Deadly nightshade (Atropa belladonna) intoxication has been infrequently reported in both children and adults in the literature. In this article, the clinical and laboratory findings of 49 children with acute deadly nightshade intoxication are reviewed. Our purpose was to enlighten the findings of deadly nightshade intoxication in childhood. The most common observed symptoms and signs were meaningless speech, tachycardia, mydriasis, and flushing. None of the children required mechanical ventilation or died in our series. The patients were categorized into two groups, mild/moderate and severe intoxication. Children with and without encephalopathy were accepted as severe and mild/moderate intoxication, respectively. While 43 children were placed in the group of mild/moderate intoxication, six were in severe intoxication group. We found that meaningless speech, lethargy, and coma were more common, but tachycardia was less common in the severe intoxication group (children with encephalopathy) (P B-0.05). In the treatment, neostigmine was used in all children because of no available physostigmine in our country. In conclusion, our findings showed that the initial signs and symptoms of acute deadly nightshade intoxication might be severe in some children, but no permanent sequel and death were seen in children. We also showed that meaningless speech, lethargy, coma, and absence of tachycardia were ominous signs in deadly nightshade intoxication in childhood. Lastly, we suggest that neostigmine may be used in cases of deadly nightshade intoxication if physostigmine cannot be available.

scholarly journals Valproate semisodium-induced encephalopathy: diet and polypharmacy interactions

2012 ◽  
Vol 36 (4) ◽  
pp. 137-139 ◽  
Author(s):  
Nuno Rodrigues Silva ◽  
Ângela Venâncio
Keyword(s):  
Case Reports ◽  
Adult Population ◽  
Paediatric Population ◽  
Valproate Semisodium ◽  
Bipolar I Disorder ◽  
Life Threatening ◽  
Life Threatening Complication

SummaryDespite extensive use of valproate in neurology and psychiatry, valproate-induced encephalopathy is a rarely reported complication. Although initially reported in the paediatric population, case reports are growing in the adult population.Clinicians need to be aware of this potentially life-threatening complication. We report a case in a 37-year-old woman with bipolar I disorder with previously uncomplicated valproate use, who developed encephalopathy when valproate was restarted a few years later. The patient has provided consent for publication.

HIV/AIDS and traditional healers: a blessing in disguise

2010 ◽  
Vol 50 (3) ◽  
pp. 154-155
Author(s):  
B L Meel
Keyword(s):  
Case Reports ◽  
Health Care Systems ◽  
Traditional Healers ◽  
Immunodeficiency Virus ◽  
Herbal Decoction ◽  
Care Systems ◽  
Life Threatening ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Hiv Aids

Traditional healers contribute significantly to the level of health-care systems in Africa. They could play an important role in the prevention and care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the community. The traditional healing system deals with psychosocial stress associated with HIV/AIDS as well as herbal medications. Sometimes, herbal medicine causes serious life-threatening complications. Two case reports are presented in this article. The first is a 48-year-old woman with HIV who was made to drink a large volume of a herbal decoction to stimulate vomiting in the belief that cleansing the bowel would rid the system of the disease. The second is a 25-year-old young man who had a herbal enema, which resulted in gangrene of the large bowel. The case histories, mechanism of action and causes of death are discussed.

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