Pronounced Metabolic Response To Modest Theophylline Overdose
intoxication; Pharmacology & Pharmacy; toxicity
OBJECTIVE: To describe a patient who developed significant metabolic abnormalities in response to a low-level theophylline ingestion. CASE SUMMARY: An 18-year-old man was examined after ingesting theophylline 3 g in a suicide attempt. Although his peak theophylline concentration was 157 mumol/L (28.2 mug/mL), it was associated with significant leukocytosis, hypokalemia, hypomagnesemia, hypophosphatemia, hyperglycemia, and lactic acidosis. These abnormalities have been previously associated with theophylline intoxication, but only in conjunction with much higher peak concentrations of theophylline. CONCLUSIONS: Significant metabolic abnormalities can occur with suicidal ingestion of relatively small amounts of theophylline. The presence of these abnormalities should be sought in theophylline overdoses. In the proper clinical circumstances, such abnormalities should raise suspicion of covert theophylline ingestion.
Hagley M T; Traeger S M; Schuckman H
Annals of Pharmacotherapy
1994
1994-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/106002809402800207" target="_blank" rel="noreferrer noopener">10.1177/106002809402800207</a>
THROMBOCYTOPENIA IN INTENSIVE-CARE PATIENTS - A COMPREHENSIVE ANALYSIS OF RISK-FACTORS IN 314 PATIENTS
vancomycin; Pharmacology & Pharmacy; antibodies; respiratory-distress syndrome; septicemia; heparin-associated thrombocytopenia; intravascular coagulation
OBJECTIVE: To define the incidence and severity of thrombocytopenia in a mixed medical-surgical population of critically ill patients and to examine factors that may be related to the development of thrombocytopenia. DESIGN: Retrospective chart review of 314 critically ill patients requiring at least 3 days of critical care. SETTING: A 17-bed combined medical-surgical intensive care unit (ICU) in a 560-bed tertiary care community hospital. PATIENTS: Medical and surgical patients admitted to the ICU. INTERVENTIONS: All medical records over the duration of the ICU stay were reviewed, All scheduled medications, including dosage and start/stop dates, were recorded. All platelet counts, placement of pulmonary artery catheters, liver function test results, and admission serum creatinine concentrations were collected. MEASUREMENT AND MAIN RESULTS: Thrombocytopenia (platelet count less than 200 x 10(9)/L) was observed frequently, but rarely reached a severe stage (7 patients). No single diagnostic category was significantly associated with thrombocytopenia alone, although the combination of sepsis syndrome/septic shock and respiratory failure was strongly correlated (p < 0.0001) with thrombocytopenia. Liver function abnormalities were correlated strongly with thrombocytopenia, and the majority of patients (5 of 7) with severe thrombocytopenia (less than 20 x 10(9)/L) were found to have concurrent severe alterations in liver function test results. Pulmonary artery catheter placement and heparin exposure were associated strongly with thrombocytopenia (p < 0.0001). Drug therapies that were correlated with thrombocytopenia included heparin and vancomycin (p < 0.05). Hemodynamic instability was correlated strongly with the presence and severity of thrombocytopenia. In a stepwise linear regression model, the admission platelet count accounted for the largest proportion of the variance (43%), followed by hemodynamic instability (8%) and the requirement for inotropic agents (2%). CONCLUSIONS: Thrombocytopenia in the critically ill occurs frequently, rarely reaches severely depressed concentrations, and primarily represents a manifestation of disease processes initiated prior to admission. Hemodynamic instability and/or heparin exposure appear to be the strongest identifiable correlates with thrombocytopenia. Although these may cause infrequent isolated cases, other specific drug causes of thrombocytopenia are not responsible for the majority of cases of thrombocytopenia in the critically ill.
Bonfiglio M F; Traeger S M; Kier K L; Martin B R; Hulisz D T; Verbeck S R
Annals of Pharmacotherapy
1995
1995-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/106002809502900901" target="_blank" rel="noreferrer noopener">10.1177/106002809502900901</a>
ANAPHYLACTOID REACTION TO INTRAVENOUS ACETYLCYSTEINE ASSOCIATED WITH ELECTROCARDIOGRAPHIC ABNORMALITIES
Pharmacology & Pharmacy; n-acetylcysteine; adverse reactions; acetaminophen overdose
OBJECTIVE: To review the potential for anaphylactoid reactions to intravenously administered acetylcysteine when used in the treatment of acetaminophen overdose. This case is unique in that electrocardiographic changes, including ST segment depression and T-wave inversion were associated with the episode and complicated the diagnosis. DATA SOURCES: Reference articles and letters are identified in the text. DATA SYNTHESIS: Intravenous administration of acetylcysteine has been used in the treatment of acetaminophen overdose. This route may be considered in some clinical situations where oral therapy is complicated. Anaphylactoid reactions, including cutaneous eruptions, flushing, chest pain, tachycardia, and fever have been reported in up to three percent of patients receiving intravenous acetylcysteine. The nature of these reactions and evidence concerning their etiology suggest a histamine-release phenomenon. Response to intervention with antihistamines and the safety of further acetylcysteine administration are discussed. CONCLUSIONS: This case illustrates a variant anaphylactoid reaction to intravenously administered acetylcysteine and emphasizes the need for practitioners to consider the potential for these reactions prior to initiation of therapy and indicates appropriate treatment of these reactions.
Bonfiglio M F; Traeger S M; Hulisz D T; Martin B R
Annals of Pharmacotherapy
1992
1992-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/106002809202600105" target="_blank" rel="noreferrer noopener">10.1177/106002809202600105</a>
A pilot pharmacokinetic-pharmacodynamic study of benzodiazepine antagonism by flumazenil and aminophylline
Pharmacology & Pharmacy; diazepam; midazolam; theophylline; volunteers
Study Objectives. To develop a pharmacokinetic-pharmacodynamic model using quantitative electroencephalographic (EEG) analysis to compare two separate benzodiazepine antagonists and generate data concerning response variability. Design. A pilot study using a randomized, blinded, crossover design. Setting. The Neurology Laboratory at the Akron City Hospital campus of SUMMA Health System. Patients. Four healthy volunteers completed the protocol. Interventions. Subjects received midazolam 0.1-0.2 mg/kg by intravenous bolus on 3 study days, separated by a minimum washout period of 1 week. Subjects participated in an initial open-label response phase followed by a randomized, crossover trial of each benzodiazepine antagonist. Measurements and Main Results. Venous blood samples were obtained to characterize the pharmacokinetics of all study compounds. The EEG parameter of total number of waves/second (recorded from FP1-F3 and FP2-F4 electrodes) in the frequency of 12-30 Hz was used to quantify effect. Flumazenil appeared to prolong the elimination half-life of midazolam significantly (p<0.05). Theophylline (aminophylline) also appeared to prolong the half-life of flumazenil (p<0.05). Despite considerable variability, flumazenil resulted in reversal of sedation at concentrations achieved by routine dosing. Resedation was apparent for all subjects following flumazenil reversal. Only partial reversal of sedation by theophylline was achieved by an aminophylline dose of 1-2 mg/kg. Conclusions. Flumazenil, was consistently effective in reversing sedation by midazolam at routinely recommended dosing. Further investigation of aminophylline as a reversal agent should use an estimated dose of 6-8 mg/kg aminophylline. To achieve adequate reversal, some patients may require aminophylline dosages that exceed safe clinical administration.
Bonfiglio M F; FisherKatz L E; Saltis L M; Traeger S M; Martin B R; Nackes N A; Perkins T A
Pharmacotherapy
1996
1996-11
Journal Article or Conference Abstract Publication
n/a
TOTAL PARENTERAL-NUTRITION BY A NUTRITION SUPPORT TEAM - IMPROVED QUALITY OF CARE
Nutrition & Dietetics
Traeger S M; Williams G B; Milliren G; Young D S; Fisher M; Haug M T
Journal of Parenteral and Enteral Nutrition
1986
1986-07
Journal Article
<a href="http://doi.org/10.1177/0148607186010004408" target="_blank" rel="noreferrer noopener">10.1177/0148607186010004408</a>
Seizures associated with ofloxacin therapy
Immunology; Infectious Diseases; intravenous ofloxacin; Microbiology
We describe four patients who had seizures while receiving ofloxacin; no other causes were evident. Common factors among all patients included advanced age and use of a high-dose regimen. The renal insufficiency of three patients and the timing of the seizures implicate accumulation of ofloxacin as a contributing factor, Other potentially related factors included electrolyte abnormalities and prior neurological insult. Improved awareness of and further investigation into the neurotoxic effects of ofloxacin may enhance its safe use.
Traeger S M; Bonfiglio M F; Wilson J A; Martin B R; Nackes N A
Clinical Infectious Diseases
1995
1995-12
Journal Article
<a href="http://doi.org/10.1093/clinids/21.6.1504" target="_blank" rel="noreferrer noopener">10.1093/clinids/21.6.1504</a>
FAILURE TO WEDGE AND PULMONARY-HYPERTENSION DURING PULMONARY-ARTERY CATHETERIZATION - A SIGN OF TOTALLY OCCLUSIVE PULMONARY-EMBOLISM
General & Internal Medicine
Traeger S M
Critical Care Medicine
1985
1985
Journal Article
<a href="http://doi.org/10.1097/00003246-198507000-00007" target="_blank" rel="noreferrer noopener">10.1097/00003246-198507000-00007</a>
CONTINUOUS-INFUSION OF PYRIDOSTIGMINE IN THE MANAGEMENT OF MYASTHENIC CRISIS
cholinergic; cholinesterase inhibitors; compounds; edrophonium; General & Internal Medicine; gravis; injections; intravenous; kinetics; myasthenia gravis; neostigmine; neuromuscular diseases; ocular motility disorders; pyridinium; pyridostigmine bromide; receptors; ventilatory weaning
Saltis L M; Martin B R; Traeger S M; Bonfiglio M F
Critical Care Medicine
1993
1993-06
Journal Article
<a href="http://doi.org/10.1097/00003246-199306000-00025" target="_blank" rel="noreferrer noopener">10.1097/00003246-199306000-00025</a>