Pharmacotherapy
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Case Reports
Successful treatment with drotrecogin alfa (activated) in a pregnant patient with severe sepsis.
Sepsis remains one of the leading causes of mortality during pregnancy. Because of the inherent limitations of conducting scientific investigations during pregnancy, a great deal of clinical decision making is based on observational reports, an understanding of the physiologic changes of pregnancy, and consideration for risk to the fetus. We describe a 20-year-old pregnant woman at 20 weeks' gestation who was admitted to an obstetric ward for dehydration and a urinary tract infection. ⋯ Approximately 17 weeks later, the patient gave birth to a 3.42-kg female infant with no congenital abnormalities. To our knowledge, this represents the second case report to describe the use of drotrecogin alfa (activated) along with the status of the mother and fetus both after completion of therapy and after subsequent delivery. Because of the threat of mortality from sepsis during pregnancy, combined with the inherent limitations associated with clinical research during pregnancy, further reports and investigation into the treatment of sepsis in the pregnant patient are warranted.
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The life-threatening DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is characterized by the presence of at least three of the following findings: fever, exanthema, eosinophilia, atypical circulating lymphocytes, lymphadenopathy, and hepatitis. This syndrome is difficult to diagnose, as many of its clinical features mimic those found with other serious systemic disorders. This idiosyncratic reaction occurs most commonly after exposure to drugs such as allopurinol, sulfonamides, and aromatic anticonvulsants such as phenytoin, phenobarbital, and carbamazepine. ⋯ Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's development of DRESS syndrome and treatment with phenytoin. Clinicians should have a high index of suspicion for the DRESS syndrome in patients being treated with aromatic anticonvulsants who develop a sepsis-like syndrome. Furthermore, considering the potential severe effects associated with phenytoin, the risks and benefits should be carefully evaluated before using this agent for seizure prophylaxis.
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Randomized Controlled Trial
Ultrasound visualization of ingested tablets: a pilot study.
To evaluate the ability of ultrasonography as a radiographic technique to visualize ingested tablets in the human stomach. ⋯ Our results do not support the application of ultrasonography to determine the presence or absence of tablets in an individual's stomach after an acute poisonings. We did show that, similar to other radiologic techniques (e.g., projection radiography), the absence of tablet visualization does not exclude their presence. However, the ultrasonographers also found several false positives. Thus, further studies are needed with larger numbers of both subjects and ultrasonographers to elucidate the potential benefit of ultrasonography in individuals who experience acute poisoning.