The American journal of emergency medicine
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Multicenter Study
Bupropion overdose: a 3-year multi-center retrospective analysis.
Bupropion (Wellbutrin; Burroughs Welcome Co, Research Triangle Park, NC) is a unique monocyclic antidepressant about which there is limited overdose information. A retrospective analysis of all bupropion ingestions reported to five regional poison control centers from 1989 through 1991 was conducted. There were 58 cases of bupropion ingestion and nine cases of combined bupropion and benzodiazepine ingestion. ⋯ Five cases of pure bupropion overdose had electrolytes reported. Serum potassium ranged from 2.6 to 4.2 mEq/L (mean, 3.3 mEq/L). In overdose, bupropion seems to lack major cardiovascular toxicity; however, it does manifest significant neurological toxicity.
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Review Case Reports
Ceramic lead glaze ingestions in nursing home residents with dementia.
Three cases of acute lead ceramic glaze ingestions that occurred in elderly patients during art therapy classes in nursing homes are reported. Initial blood lead levels were 109 micrograms/dL (5.23 mumol/L), 259 micrograms/dL (10.43 mumol/L), and 85 micrograms/dL (4.08 mumol/L), respectively, and all patients underwent chelation therapy. ⋯ Ceramic lead glaze ingestions among institutionalized patients may be more common than generally appreciated and occasionally are associated with significant morbidity or, rarely, mortality. Simple preventive measures could eliminate the majority of such occurrences.
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Comparative Study
Normal amylase levels in the presentation of acute pancreatitis.
Recent literature suggests that serum amylase levels are not an appropriate screen for the diagnosis of acute pancreatitis because specificity and sensitivity are poor. Evidence from several studies supports the use of lipase determinations to diagnose acute pancreatitis, and recent improvements in this assay have made it more readily available to the emergency physician. This retrospective review compares the use of serum amylase to lipase levels in the diagnosis of acute pancreatitis in 52 patients who presented to the emergency department, with the hospital discharge diagnosis serving as the gold standard to which the assays were compared. Serum lipase was found to be more sensitive than serum amylase (95% vs 79%); serum amylase levels decreased to normal significantly faster than lipase levels.
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Ethanol intoxication has been widely reported as a cause of lactic acidosis. To determine the frequency and severity of ethanol-induced lactic acidosis, patients who presented to an emergency department with a clinical diagnosis of acute ethanol intoxication and a serum ethanol concentration of at least 100 mg/dL were studied. Arterial blood was sampled for lactate and blood gas determinations. ⋯ Only one case with elevated blood lactate concentration had associated acidemia. Significant elevations of blood lactate are uncommon in acute ethanol intoxication. In patients with ethanol intoxication who are found to have lactic acidosis, other etiologies for the elevated lactate level should be considered.