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>
Assessment of serum creatine kinase among adolescent patients following jimsonweed (Datura stramonium) and moonflower (Datura inoxia) ingestions: a review of 11 cases
Adolescent; Toxicology; Intoxication; Anticholinergics; induced rhabdomyolysis; Intoxication; presentations; Rhabdomyolysis; Toxic plants
Introduction. Datura stramonium (DS) (jimsonweed) is well known for its abuse potential for hallucinogenic effects and Datura inoxia (DI) (moonflower) has been abused for similar effects. To our knowledge, only one case report describes rhabdomyolysis in association with DS or DI ingestion. Case identification and details. Patient hospital charts were retrospectively screened from January 1, 2002 to December 31, 2007 to identify patients with qualifying ICD-9 codes for toxic plant ingestions. We report on 11 patient cases of DS/DI ingestions in which serum creatine kinase (CK) concentrations were monitored. These admissions occurred at our hospital over a 6-year period. Serum CK concentrations ranged from 72 to 70,230 U/L. Only three patients had serum CK concentrations greater than 1,000 U/L. One patient with a peak concentration of 70,230 U/L and a positive myoglobinuria was diagnosed with rhabdomyolysis. Discussion. Based on our review of the literature and these cases, it is possible that serum CK concentrations may be elevated more frequently than previously realized. The clinical significance of this abnormal laboratory value is uncertain with the majority of patients remaining asymptomatic without any clinical evidence of rhabdomyolysis.
Blackford M G; Fitzgibbon J J; Reed M D
Clinical Toxicology
2010
2010-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3109/15563651003772946" target="_blank" rel="noreferrer noopener">10.3109/15563651003772946</a>
EXCITED DELIRIUM SYNDROME (EXDS): DEFINING BASED ON A REVIEW OF THE LITERATURE
acidosis; agitated delirium; cardiac-arrest; cocaine users; custody; Emergency Medicine; excited delirium; in-custody death; intoxication; patient; psychosis; restraint; sudden death; sudden death; TASER
Background: Patients present to police, Emergency Medical Services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, "superhuman'' strength, diaphoresis, and lack of willingness to yield to overwhelming force. Acertain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as "Excited Delirium'' deaths. Objectives: This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Discussion: Excited delirium syndrome is characterized by delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Conclusions: Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies. (C) 2012 Elsevier Inc.
Vilke G M; DeBard M L; Chan T C; Ho J D; Dawes D M; Hall C; Curtis M D; Costello M W; Mash D C; Coffman S R; McMullen M J; Metzger J C; Roberts J R; Sztajnkrcer M D; Henderson S O; Adler J; Czarnecki F; Heck J; Bozeman W P
Journal of Emergency Medicine
2012
2012-11
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2011.02.017" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2011.02.017</a>
The relationship between psychiatric medication and course of hospital stay among intoxicated trauma patients
acute; brain-injury; chronic alcohol-abuse; comorbidity; cost; disorders; Emergency Medicine; ethanolism; general hospitals; hospitalization; inpatients; intoxication; Length of Stay; pneumonia; prevalence; Psychiatry; trauma
Introduction The purpose of this study was to determine whether trauma patients requiring psychiatric medication who were admitted with positive alcohol or drug screen require more pain medications or sedation resulting in longer length of stay. Methods Data were retrospectively collected from 1997 through 2003 on patients with positive alcohol or drug screen who also received psychiatric medication during their hospital stay in a trauma center. Patients were matched by age, injury severity score, and injury to controls who had negative alcohol and toxicology screens and no psychiatric medication. An additional group consisted of positive alcohol or drug-screen trauma patients without psychiatric medication during hospitalization. Each group had 25 patients. Results No significant differences between the three groups regarding comorbidities or pain-medication doses given per day were found. The patients with positive alcohol and with psychiatric medication were more likely to have respiratory complications such as pneumonia or respiratory failure requiring ventilator support (36 versus 4%, P=0.005), to develop other infections (8 versus 0%), or other complications (26 versus 4%, P=0.0007) compared with the controls. A significant difference in hospital length of stay between the group with positive toxicity and psychiatric medication and that with negative toxicity and psychiatric medication (mean: 12.8 and 5.5 days, respectively; P=0.01) was found. Conclusion Psychiatric medication and positive drug or alcohol screens are associated with longer length of stay and increased respiratory complications. Factors influencing these outcomes need more clarification and prospective studies.
Muakkassa F F; Marley R A; Dolinak J; Salvator A E; Workman M C
European Journal of Emergency Medicine
2008
2008-02
Journal Article
<a href="http://doi.org/10.1097/MEJ.0b013e3280b17ea0" target="_blank" rel="noreferrer noopener">10.1097/MEJ.0b013e3280b17ea0</a>