Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Tramadol overdose impairs consciousness and may induce ECG changes and convulsions. These effects may be opioid and/or serotonin related. This study describes clinical manifestations, electrophysiological and hemodynamic findings, and the frequency of potential serotonin syndrome in tramadol overdose in a case series. It also focuses on potential factors by which convulsions could be predicted. ⋯ In tramadol overdose, mydriasis or tachycardia appears to indicate a higher risk for seizure. Management may need to be focused on both mu-opioid agonism and potential mild serotonin syndrome.
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The toxicokinetics of sustained-release bupropion are not well described. ⋯ Bezoar formation may underlie these differences. Interventions which reduce the absorption of sustained release bupropion may be effective in overdose.
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Clin Toxicol (Phila) · May 2010
ReviewWhat is the role of lidocaine or phenytoin in tricyclic antidepressant-induced cardiotoxicity?
Tricyclic antidepressant (TCA) poisoning is a relatively common occurrence and remains a significant cause of mortality and morbidity. Deaths from TCA toxicity are typically due to cardiovascular events such as arrhythmias and hypotension. Cardiovascular toxicity may be multifactorial. However, the primary mechanism is a TCA-induced membrane-depressant or "quinidine-like" effect on the myocardium resulting in slowing down of phase 0 depolarization of the cardiac action potential and subsequent impairment of conduction through the His-Purkinje system and myocardium. This effect is manifest as QRS prolongation on the EKG, atrioventricular (AV) block, and impairment in automaticity leading to hypotension and ventricular dysrhythmia. Primary treatment strategies include sodium bicarbonate, hypertonic saline, and correction of any conditions that may aggravate this toxicity such as acidosis, hyperthermia, and hypotension. In cases of severe TCA toxicity, administration of sodium bicarbonate may be insufficient to correct the cardiac conduction defects. Use of lidocaine or phenytoin, both Vaughan Williams Class IB antiarrhythmic agents, has been reported as an effective adjunctive therapy in cases of severe cardiotoxicity. ⋯ Although there appears to be more evidence for the use of lidocaine than phenytoin as adjunctive treatment for TCA-associated cardiotoxicity, specific clinical indications and dosing recommendations remain to be defined. We recommend the use of lidocaine in cases in which cardiotoxicity (arrhythmias, hypotension) is refractory to treatment with sodium bicarbonate or hypertonic saline, or in which physiological derangement (e.g., severe alkalosis or hypernatremia) limits effective use of these primary strategies.
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Clin Toxicol (Phila) · May 2010
Case ReportsIatrogenic lipid emulsion overdose in a case of amlodipine poisoning.
Intralipid therapy has been used successfully as "rescue therapy" in several cases of overdose. We present a case of iatrogenic lipid emulsion overdose because of a dosing error. ⋯ Lipid emulsion overdose caused no detectable acute adverse hemodynamic effects. The following laboratory values were unobtainable immediately after infusion: white blood cell count, hemoglobin, hematocrit, platelet count, and a metabolic panel of serum electrolytes. Ultracentrifugation of blood allowed for detection of a metabolic panel 3 h after the infusion. Centrifuged hematocrits appeared to be higher than expected.
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Clin Toxicol (Phila) · May 2010
Early laryngeal injury and complications because of endotracheal intubation in acutely poisoned patients: a prospective observational study.
Tracheal intubation may represent a life-saving supportive measure in many acutely poisoned patients. Although considered as a safe procedure, intubation may rapidly damage laryngeal mucosa. The incidence and nature of short-duration intubation-associated laryngeal injuries are unknown in the population of poisoned patients. ⋯ Despite short-duration intubation, poisoned patients are at high risk of initial laryngeal injury.