The American journal of emergency medicine
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Case Reports
The possibility of the treatment for long-acting injectable antipsychotics induced severe side effects.
We present the case of a 47-year-old man with schizophrenia who developed acute and persistent circulatory failure after receiving injections of paliperidone palmitate. We measured blood concentrations of paliperidone and performed resection of hip tissues, where paliperidone palmitate was suspected to be present, in order to reduce the side effects. ⋯ We suggest that resection of the tissues suspected of containing paliperidone palmitate can help reduce its severe side effects. However, identifying the site of injection is essential.
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Childhood obesity remains a serious problem in the United States. Significant associated adverse incidents have been reported with sedation of children with obesity, namely hypoxemia. The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight. ⋯ The results indicate that children with obesity are almost twice as likely to have a desaturation related to procedural sedation compared with children of other weight status. Providers should be aware that children with obesity may be more likely to desaturate than other children, and therefore be skilled at recognizing this.
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Several studies reported Pv-aCO2/Ca-vO2 ratio as a surrogate of VCO2/VO2 to detect global tissue hypoxia. The present study aimed to evaluate the prognostic value of Pv-aCO2/Ca-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock. ⋯ Combination of Pv-aCO2/Ca-vO2 ratio and lactate at early stages of resuscitation of septic shock can better predict the prognosis of patients. The Pv-aCO2/Ca-vO2 ratio may become a useful parameter supplementary to lactate in the resuscitation of septic shock.
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To report a case of successful use of unfractionated heparin (UFH) infusion to treat cerebral venous sinus thrombosis (CVST). ⋯ UFH may be considered as one of the pharmacological agents to manage CVST. The dosing for UFH bolus and infusion is similar to treatment dose for pulmonary embolism/deep vein thrombosis management with goal anti-Xa between 0.3 and 0.7units/mL.
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Case Reports
Hyperkalemia and cardiac arrest associated with glucose replacement in a patient on spironolactone.
We present a case of hypoglycemia, which after intravenous glucose replacement, led to cardiac arrest secondary to a profound extracellular potassium shift. The patient was on spironolactone therapy which is known to cause aldosterone resistance (which inhibits the body's ability to prevent potassium shifts) [1]. ⋯ Knowledge of this case may prompt further monitoring, repeat lab testing, and careful medication reconciliation before discharging a patient with risk for aldosterone resistance. On our literature review, we have not found additional reports where this particular physiology led to cardiac arrest.