The American journal of emergency medicine
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2,4-Dinitrophenol (DNP) is a known uncoupler of oxidative phosphorylation that clinically results in hyperthermia, tachycardia, tachypnea, and metabolic acidosis. Overdoses of DNP are often fatal and there is no specific reversal therapy. Dantrolene interferes with calcium release in skeletal muscle and is traditionally used to treat malignant hyperthermia. There has been limited published data on its use in DNP toxicity. We present two cases of DNP toxicity that were treated with dantrolene. CASE 1: A 22-year-old male presented following an overdose of his bodybuilding supplements including DNP. He became altered, tachycardic, and hyperthermic to 40.0C. He required intubation and aggressive cooling. He received multiple doses of dantrolene over the initial 36 h with resolution of his hyperthermia. He was extubated and discharged home on hospital day 6. CASE 2: A 20-year-old male presented following a staggered ingestion of DNP. He was tachypneic and tachycardic on arrival. He became hyperthermic to 40.2C and required intubation. He underwent aggressive cooling and received 200 mg of IV dantrolene. His temperature normalized, however, he expired 4 h after ED arrival. ⋯ DNP toxicity has limited treatment options. Dantrolene may ameliorate the hypermetabolic state in DNP toxicity by lessening excitation-contraction coupling in muscle cells and improving the associated hyperthermia. Our cases demonstrate the hyperthermia reducing effects of dantrolene in DNP toxicity and contribute to the existing literature on this topic. Being aware of the possible use of dantrolene to treat the associated hyperthermia could assist emergency physicians in the treatment of DNP toxicity.
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We report here the case of a patient with perindopril intoxication inducing severe bradycardia together with a profound hypotension. Initiation of a naloxone infusion completely resolved those symptoms. As a consequence, we could recommend as a first step the use of naloxone in order to prevent the use of more invasive therapeutic tools.
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We study community-level factors associated with emergency department (ED) admission rates and assessed how they vary across geography. ⋯ In 3031 U.S. counties, the ED admission rate varied from 3.9% to 82.2%. The lowest ED admission rates were concentrated in counties in Kansas, Oregon, and Vermont and the highest ED admission rates were in counties throughout Washington, Wyoming, Texas, and Colorado. The OLS model found several community-level factors that negatively impacted admission rates, specifically hospital market concentration, the rate of hospital beds with urgent care, and the rate of hospital beds. The factors that had a positive impact on the admission rate include the rate of MDs and factors for disadvantage, affluence, and foreign born/Hispanic. However, GWR showed the relationship between the ED admission rate and predictors varied across U.S. counties CONCLUSIONS: The association between healthcare market concentration, healthcare delivery, and socioeconomic factors with ED admissions differed across communities in Medicare beneficiaries. This suggests that policy and interventions to reduce ED admissions need to be tailored to specific community contexts.
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This study explored the therapeutic approaches used for end-of-life (EOL) patients admitted to the emergency department (ED) and examined whether the decision to perform life-extending treatment (LET) or to allow natural death (AND) depends on patient characteristics, medical staff variables, and ED setting. ⋯ The therapeutic approach used for EOL patients in the ED depends on variables in all three treatment layers: patient, medical staff, and ED setting. Applicable national programs should be developed to ensure that no external factors influence the dying-process decision.