Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsMassive caffeine overdose requiring vasopressin infusion and hemodialysis.
Massive caffeine overdose is associated with life-threatening hemodynamic complications that present challenges for clinicians. We describe the highest-reported serum concentration of caffeine in a patient who survived and discuss the first-reported use of vasopressin and hemodialysis in a caffeine-poisoned patient. ⋯ Hemodialysis and vasopressin infusions may be of benefit in the management of caffeine-intoxicated patients who fail to respond to standard therapies.
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J. Toxicol. Clin. Toxicol. · Jan 2003
Electrophysiologic and hemodynamic effects of sodium bicarbonate in a canine model of severe cocaine intoxication.
Cocaine toxicity causes myocardial depression, malignant dysrhythmias, and sudden death, partially due to cocaine-related myocardial sodium channel blockade. Because of cocaine's ability to block cardiac sodium channels, sodium bicarbonate (NaHCO3) has been proposed as an antidote. The hypothesis of this study was that NaHCO3 would correct cocaine-induced conduction abnormalities and resultant hemodynamic compromise in an animal model simulating severe cocaine intoxication. ⋯ NaHCO3 improved ECG changes secondary to cocaine toxicity and improved myocardial function.
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsIrreversible ischemic hand following intraarterial injection of zolpidem powder.
Intraarterial injections of crushed oral formulations of drugs may cause acute, severe ischemia, and gangrene. A 24-yr-old woman developed severe ischemia of the right hand following arterial self-injection of a crushed zolpidem tablet. ⋯ Zolpidem tablets contain microcrystalline cellulose, an approved structural element in tablets for humans that has also been found to be a potent embolic agent. Microvascular embolization related to the microcrystalline cellulose may have contributed to the ischemia of the patient's hand.
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsBaclofen withdrawal following removal of an intrathecal baclofen pump despite oral baclofen replacement.
Intrathecal baclofen is used as a muscle relaxant and antispasmodic in cases of spasticity resulting from central nervous system trauma. The baclofen withdrawal syndrome may include hyperthermia, tachycardia, hypertension, seizures, altered mental status, and psychomotor agitation. We report a case in which the removal of a baclofen pump lead tothe development of severe withdrawal symptoms despite oral baclofen replacement therapy. In order to avoid the development of withdrawal, adequate doses of GABA agonist agents should be administered immediately prior to, and following, baclofen pump removal.