scholarly journals Lipid therapy for the treatment of a refractory amitriptyline overdose

CJEM ◽  
2012 ◽  
Vol 14 (03) ◽  
pp. 193-197 ◽  
Author(s):  
Mathew B. Kiberd ◽  
Samuel F. Minor
Keyword(s):  
Lipid Emulsion ◽  
Case Reports ◽  
Hemodynamic Instability ◽  
Tricyclic Antidepressant ◽  
Intentional Ingestion ◽  
Wide Complex Tachycardia ◽  
Whole Bowel Irrigation ◽  
Level Of Consciousness ◽  
Amitriptyline Overdose ◽  
Multiple Episodes

ABSTRACT Tricyclic antidepressant (TCA) overdose is a leading cause of death among intentional overdoses. Intravenous lipid emulsion therapy is an emerging antidote for local anesthetic toxicity, and there is animal evidence that lipid therapy may be efficacious in TCA overdose. Furthermore, case reports in humans have described the use of lipid therapy to reverse the toxicity of other lipophilic drugs. Here we report a 25-year-old female presenting with coma and hemodynamic instability following intentional ingestion of amitriptyline. She had multiple episodes of pulseless wide-complex tachycardia despite conventional treatment with chest compressions, cardioversion, lidocaine, epinephrine, norepinephrine, magnesium sulphate, sodium bicarbonate, activated charcoal, and whole bowel irrigation. Twenty percent lipid emulsion was administered intravenously (an initial 150 mL bolus, followed by an infusion at 16 mL/h and a second bolus of 40 mL) over 39 hours (total dose 814 mL) yet resulted in no dramatic changes in hemodynamics or level of consciousness. However, there was a decrease in the frequency of wide-complex tachycardia during the lipid emulsion infusion and a recurrence of wide-complex tachycardia shortly after the infusion was stopped. The patient was discharged from the intensive care unit 11 days later with no lasting physiologic sequelae.

Methylene blue is not contraindicated to treat hemodynamic instability in pediatric and neonate patient

2021 ◽  
Vol 17 ◽  
Author(s):  
Walusa A. Gonçalves-Ferri ◽  
Agnes A.S. Albuquerque ◽  
Patricia Martinez Evora ◽  
Paulo R.B. Evora
Keyword(s):  
Methylene Blue ◽  
Side Effects ◽  
Infusion Rate ◽  
Case Reports ◽  
Hemodynamic Instability ◽  
Exclusion Criteria ◽  
Old Patients ◽  
Randomized Clinical Study ◽  
Dose Infusion ◽  
Administration Timing

: The present review was carried out to describe publications on the use of methylene blue (MB) in pediatrics and neonatology, discussing dose, infusion rate, action characteristics and possible benefits for a pediatric patient group. The research was performed on the data sources PubMed, BioMed Central, and Embase (updated on Aug 31, 2020) by two independent investigators. The selected articles included human studies that evaluated MB use in pediatric or neonatal patients with vasoplegia due to any cause, regardless of the applied methodology. The MB use and 0 to18-years-old patients with vasodilatory shock were the adopted criteria. Exclusion criteria were the use of MB in patients without vasoplegia and patients ≥ 18-years-old. The primary endpoint was the increase in mean arterial pressure (MAP). Side effects and dose were also evaluated. Eleven studies were found of which 10 were case reports and 1 was a randomized clinical study. Only two of these studies were with neonatal patients (less than 28 days-old), reporting a small number of cases (1 and 6). All studies described positive action of MB on MAP, allowing the decrease of vasoactive amines in several of them. No severe side effects or death related to the use of the medication was reported. The maximum dose used was 2 mg/kg, but there was no consensus on the infusion rate and drug administration timing. Finally, no theoretical or experimental basis sustains the decision to avoid MB in children claiming it can cause pulmonary hypertension. The same goes for the concern of a possible deleterious effect on inflammatory distress syndrome.

scholarly journals Brain Catastrophe presented with endocrine disruption

2020 ◽  
Vol 8 (5) ◽  
pp. 104-110
Author(s):  
Saadi JS AlJadir
Keyword(s):  
Dynamic Testing ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Initial Manifestation ◽  
Altered Level ◽  
Identifiable Risk Factor ◽  
Conflicting Evidence ◽  
Level Of Consciousness ◽  
Threatening Condition ◽  
Life Threatening

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

Cholesterol Embolism in Intensive Care Patients

1993 ◽  
Vol 8 (2) ◽  
pp. 91-102 ◽  
Author(s):  
Lisa L. Kirkland
Keyword(s):  
Case Reports ◽  
Supportive Therapy ◽  
Hemodynamic Instability ◽  
Cholesterol Embolism ◽  
Intensive Care Patients ◽  
Major Organ ◽  
Life Threatening ◽  
Perineal Gangrene ◽  
Long Term Prognosis

Four case reports are presented, followed by a discussion of the acute, potentially life-threatening manifestations of the cholesterol embolism syndromes. Every major organ system except the lungs may be directly affected by cholesterol emboli; devastating consequences encompass cerebral, myocardial, spinal cord, intestinal, renal, and other visceral organ infarction, as well as peripheral and perineal gangrene. Additional complications include severe hypertension, gastrointestinal bleeding, and hemodynamic instability. Anticoagulants and thrombolytic therapy may exacerbate atheromatous embolism and are relatively contraindicated. Aggressive supportive therapy may improve chances of survival, but long-term prognosis is poor. Prevention remains the most important aspect in this devastating disorder.

scholarly journals Leiomyomas and massive digestive hemorrhages: Case reports of patients diagnosed in 2004

2007 ◽  
Vol 60 (5-6) ◽  
pp. 292-294 ◽  
Author(s):  
Gradimir Golubovic ◽  
Dusica Celeketic ◽  
Milosav Kiurski ◽  
Ratko Tomasevic ◽  
Dragana Stankovic ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Case Reports ◽  
Muscularis Propria ◽  
Clinical Pathology ◽  
Final Diagnosis ◽  
Hemodynamic Instability ◽  
Gastrointestinal Tumors ◽  
Submucosal Tumors ◽  
Common Location ◽  
Precise Diagnosis

Introduction: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. Case report: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathological findings), and at the same time a definite therapeutic procedure. Discussion and conclusion: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.

scholarly journals Persistent delusional theme over 13 episodes of psychotic depression

2013 ◽  
Vol 25 (6) ◽  
pp. 370-373 ◽  
Author(s):  
Søren Dinesen Østergaard ◽  
Anne Katrine K. Leadholm ◽  
Anthony J. Rothschild
Keyword(s):  
Case Report ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Psychotic Symptoms ◽  
Psychotic Depression ◽  
Medical File ◽  
Course Of Illness ◽  
Clinical Phenomenon ◽  
Initial Episode ◽  
Multiple Episodes

ObjectiveUnipolar psychotic depression (PD) is a highly debilitating condition, which needs intense monitoring and treatment. Among patients with recurrent PD, delusions tend to be very similar or identical over several separate episodes during the course of illness, but case reports illustrating this clinical phenomenon in detail are lacking from the literature.MethodsCase report describing the 45-year-old Ms. J, who has experienced multiple episodes of PD. The report is based on a review of her medical file.ResultsThe delusional theme of Ms. J's initial episode of PD reappeared at several subsequent episodes. During the majority of admissions, Ms. J was treated with electroconvulsive therapy, which resulted in significant improvement in the depressive, psychotic and catatonic features.ConclusionMs. J's case illustrates that PD can be a stable phenotype over many episodes and that it is important to recognise psychotic symptoms in order to prescribe the best possible treatment.

scholarly journals Massive Secondary Cutaneous Meningioma with Extension to the Face

2020 ◽  
Vol 11 ◽  
pp. 209
Author(s):  
Turki Elarjani ◽  
Meshari Alhuthayl ◽  
Maher Hassounah
Keyword(s):  
Multidisciplinary Approach ◽  
Case Reports ◽  
World Health ◽  
Intracranial Meningioma ◽  
Bone Invasion ◽  
Code Status ◽  
Level Of Consciousness ◽  
The Face ◽  
Grade 3 ◽  
Health Organization

Background: Cutaneous meningioma is a very uncommon pathologic entity that can be divided into primary and secondary types. Secondary cutaneous meningioma arises from an intracranial meningioma through metastasis, seeding during surgery, or direct bone invasion. There are limited published case reports correlating the development of cutaneous meningioma to high-grade convexity meningioma. Case Description: A 63-year-old man underwent total resection of a right frontal convexity meningioma, World Health Organization Grade I in 2001. He presented in 2016 with a small frontal cutaneous mass over the craniotomy site. Computed tomography showed extracranial and intracranial components of the meningioma. The patient declined surgical intervention and lost to follow. One and half years later, he underwent resection of the growing ulcerating cutaneous component in an outside hospital. The pathological diagnosis was Grade 3 meningioma. Six months later, he presented to us with a massive cutaneous meningioma and large intracranial component. Surgical resection and multidisciplinary management were planned. The patient was very hesitant to have surgery but settled for receiving radiation. Seven months after radiation, he presented with a decreased level of consciousness and skin necrosis with maggot infestation. His code status was changed to “do not attempt resuscitation,” and he died 3 days later in December 2019. Conclusion: Large intracranial meningiomas with massive transosseous extension to the scalp pose a significant challenge to the treating team. Proper planning and a multidisciplinary approach are essential. However, prognosis remains generally poor.

scholarly journals A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

CJEM ◽  
2016 ◽  
Vol 19 (04) ◽  
pp. 256-264 ◽  
Author(s):  
Shazma Mithani ◽  
Kathryn Dong ◽  
Ashlea Wilmott ◽  
Heather Podmoroff ◽  
Nadim Lalani ◽  
...  
Keyword(s):  
Lipid Emulsion ◽  
Beta Blockers ◽  
A Priori ◽  
Hemodynamic Instability ◽  
Primary Objective ◽  
Future Research ◽  
Poison Center ◽  
Channel Blockers ◽  
Intravenous Lipid Emulsion ◽  
Change In Mean

AbstractObjectivesIntravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered.MethodsConsecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014. Patients were enrolled if they ingested a drug, developed hemodynamic instability, failed conventional treatment, and received ILE therapy. Data were collected by medical record review. The primary outcome was the change in mean arterial pressure (MAP) in the first hour after ILE administration. Secondary outcomes included survival, length of stay, and the effect of drug class on patient outcome.ResultsThirty-six patients were enrolled. Agents ingested included calcium channel blockers and beta blockers (10/36, 27.8%), tricyclic antidepressants (5/36, 13.9%), bupropion (3/36, 8.3%), and antiepileptic agents (1/36, 2.8%). Seventeen patients (47.2%) ingested multiple agents. Twenty-five patients survived (69.0%). Overall, MAP increased by 13.79 mm Hg (95% CI 1.43–26.15); this did not meet oura prioridefinition of clinical significance.ConclusionsOur study did not find a clinically important improvement in MAP after ILE administration. Until future research is done to more definitively study its efficacy, ILE should remain a potential treatment option for hemodynamically unstable overdose patients only after conventional therapy has failed.

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