Human & experimental toxicology
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A crucial role of nitric oxide in acute lung injury secondary to the acute necrotizing pancreatitis.
To investigate the role of nitric oxide (NO) in acute lung inflammation and injury secondary to acute necrotizing pancreatitis (ANP), 5% sodium taurocholate was retrogradely injected into the biliopancreatic duct of rats to ANP model. These ANP rats were given L-Arginine (L-Arg, 100 mg/kg), L-NAME (10 mg/kg), or their combination by intraperitoneal injection 30 min prior to ANP induction. At 1, 3, 6, and 12 hours after ANP induction, lung NO production, and inducible NO synthase (iNOS) expression were measured. ⋯ These markers were slightly attenuated by pretreatment with combination of L-Arg + L-NAME, suggesting that NO is required for initiating the acute lung damage in ANP rats, and also that L-Arg-enhanced lung injury is mediated by its NO generation rather than its direct effect. MPO activity and TNF-alpha expression in lung were upregulated in the ANP rats and further enhanced by pretreatment with L-Arg and attenuated by pretreatment with L-NAME, respectively. These results suggest that overproduction of NO mediated by iNOS in the lung is required for the acute lung inflammation and damage secondary to ANP.
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Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay. ⋯ ADR to IV-NAC were common among patients with acetaminophen overdose, but mostly minor and all reported adverse reactions were easily managed.
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The principal toxic ingredients of aconite roots include aconitine, mesaconitine and hypaconitine, which are known cardiotoxins and neurotoxins. A 58-year-old man took a decoction of 11 g each of processed 'chuanwu' (the main root of Aconitum carmichaeli) and processed 'caowu' (the root of A. kusnezoffii) as treatment for his neck pain. One hour later, he experienced numbness of tongue and the four limbs, generalized weakness, nausea, vomiting, diarrhoea and dizziness. ⋯ He had bradycardia for 36 hours (6-41 hours after ingestion), with a heart rate of 45-68 beats/min (mean 56.5). On discharge (48 hours after ingestion), his blood pressure was 117/82 mmHg and heart rate 70 beats/min. In patients with aconite poisoning, prolonged hypotension and sinus bradycardia may occur and supportive therapy with close monitoring of blood pressure and cardiac rhythm are essential.
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Scorpion envenomation is a common public health problem worldwide and children are at greater risk of developing severe cardiac, respiratory and neurological complications. The aim of this study was to evaluate the effects of antivenin and/or prazosin use on prognosis of scorpion-envenomed children admitted to pediatric intensive care unit (PICU). ⋯ The current management of children with severe scorpion envenomation consists of administration of specific antivenom and close surveillance in a PICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The aggressive medical management directed at the organ system specifically can be effective. Our data indicated that when admission to hospital is late, the beneficial effect of antivenom and/or prazosin is questionable in severe scorpion stings.
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Comparative Study
Comparison of arterial and capillary blood gas values in poisoning department assessment.
The aim of this study was to compare simultaneously obtained arterial and capillary blood gas (CBG) values in comatose-poisoned patients presented with stable vital signs. Forty-five adult patients with a diagnosis of coma because of poisoning and stable vital signs were included in this prospective study. With respect to pH, the arterial blood gas (ABG) and CBG values correlated satisfactorily (r(2) = .91) and had an acceptable limit of agreements (LOAs; -0.04 to 0.06). ⋯ A capillary PCO(2) of 51.7 mm Hg had a sensitivity of 100% and a specificity of 95.12% for detecting hypercarbia (area under the curve, 0.99; 95% Confidence Interval, 0.90-0.99; p < .0001). In conclusion, CBG analysis for pH may be a reliable substitute for ABG analysis in the initial evaluation of patients presenting with coma and stable vital signs to the poisoning emergency department (PED). Subsequent ABG may be required in patients with capillary PCO(2) > 51.7 mm Hg.