Glasgow Coma Scale and Its Components on Admission: Are They Valuable Prognostic Tools in Acute Mixed Drug Poisoning?

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning

Demographic Factors, Duration and Costs of Hospitalization, and Causes of Death in Patients Intoxicated with Opioids and Amphetamines

Background: Intoxications are medical emergencies and among the significant causes of morbidity and mortality worldwide. In recent years, prevalence of intoxication with opioids and stimulants, such as amphetamines, is increasing particularly among young people. In this study, we investigated demographic factors, duration of hospitalization, costs of hospitalization, and cause of death in patients intoxicated with amphetamines and opioids.Materials and Methods: This study was a prospective descriptive–analytic study. Sampling method was census, and Subjects were patients intoxicated with amphetamines and opioids, alone or combined, who referred to toxicology ward of Ali-Asghar hospital in Isfahan, from October 2009 to April 2010.Results: During 6 months, among 2325 subjects, 419 patients used opioids, 98 patients used amphetamines, and 25 patients used both of them. The mean age of patients in the three groups was not significantly different. Most patients were male in all groups. The most common route of intoxication was orally in opioid group and inhalation in amphetamine group. The most common cause of intoxication was intentional attempt. Vital signs at admission were normal in three groups, but the average of heart rate, body temperature, respiratory rate and blood pressure, was slightly higher in the amphetamine group than the opioid group. Duration and cost of hospitalization were not significantly different between groups. Four patients were died totally and the outcome was not significantly different between groups. The mean age and duration of hospitalization were significantly higher in died compared to living patients.Conclusion: Opioids and amphetamines accounted for high percentages of intoxication, especially in young single men with self-employed job. Therefore, control and prevention of opioids and amphetamines consumption are important ways to reduce this kind of intoxication in this group

Effect of Antioxidants on the Outcome of Therapy in Paraquat-intoxicated Patients

Purpose: The present study was conducted to determine the effect of vitamins C and E administration on the outcome of therapy in patients with paraquat intoxication admitted in the Poisoning EmergencyDepartment (PED) of Noor Teaching General Hospital, Isfahan, Iran.Methods: We studied retrospectively medical records of 186 patients admitted to the PED in two different study periods: 157 patients were evaluated from 1985 to 2001 (first study period) in which patients received conventional treatment protocol consisting of fluid replacement, oral absorbents, haemodialysis, etc, Also, 29 other patients were assessed from 2001 to 2005 (second study period) in which vitamins C and E had been administered to the patients, in addition to the conventional protocol.The patients' mortality rate after the first study period was compared to that of the second one, with regard to the impact of the additional therapeutic intervention (use of antioxidant vitamins).Results: Most of the patients (40.5 %) had ingested more than 20 mL of 20 % paraquat solution and were admitted to the hospital during the first 4 h after exposure. Paraquat poisoning was more common in men (76.6 %), young adults in the age group 19 - 34 (47 %) and during summer (43.3 %). Mean (± SE) length of hospital stay was 62.6 ± 15.6 h. Overall mortality rates were 31 and 55.2 % in the first and second periods, respectively.Conclusion: Although the addition of antioxidants (vitamins C and E) to the conventional therapy did not reduce the mortality rate, other dependent variables including different doses of antioxidants may beconsidered for future studies

Glasgow Coma Scale and Its Components on Admission: Are They Valuable Prognostic Tools in Acute Mixed Drug Poisoning?

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning

Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review

Background: Healthcare-acquired hypernatremia (serum sodium >145 mEq/dL) is common among critically ill and other hospitalized patients and is usually treated with hypotonic fluid and/or diuretics to correct a “free water deficit.� However, many hypernatremic patients are eu- or hypervolemic, and an evolving body of literature emphasizes the importance of rapidly returning critically ill patients to a neutral fluid balance after resuscitation. Objective: We searched for any randomized- or observational-controlled studies evaluating the impact of active interventions intended to correct hypernatremia to eunatremia on any outcome in volume-resuscitated patients with shock and/or sepsis. Data sources: We performed a systematic literature search with studies identified by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, IndexCatalogue of the Library of the Surgeon General’s Office, DARE (Database of Reviews of Effects), and CINAHL and scanning reference lists of relevant articles with abstracts published in English. Data synthesis: We found no randomized- or observational-controlled trials measuring the impact of active correction of hypernatremia on any outcome in resuscitated patients. Conclusion: Recommendations for active correction of hypernatremia in resuscitated patients with sepsis or shock are unsupported by clinical research acceptable by modern evidence standards.ECU Open Access Publishing Support Fun

Atopic diseases: Risk factor in developing adverse reaction to intravenous N-Acetylcysteine

Background: N-acetylcysteine (NAC) is the choice treatment for acetaminophen overdose. The main side effect of intravenous NAC therapy is anaphylaxis or anaphylactoid reactions. We investigated the prevalence of anaphylactoid or anaphylaxis reactions to IV-NAC therapy in acetaminophen poisoned patients with atopic disease.
 Methods: A case series antrograde and descriptive–analytic study was done on acetaminophen poisoned patients who treated with IV-NAC from September 2003 to September 2004 in Isfahan, Iran.
 Results: Of 173 infused IV-NAC patients, 77 patients (44.5%) developed an anaphylactoid reaction. Its side effects was nausea and vomiting (n=49, 63.15%), flashing (n=23, 30.26%), bronchospasm (n=20, 26.31%), vertigo (n=18, 23.68%), skin rash (n=25, 32.36%) and hypotension (n=12, 15.75%). Also, 71 patients (41%) had history of atopic disease. Atopic diseases were asthma (n=12, 6.9%), atopic dermatitis (n=7, 4%), allergic rhinitis (n=5, 2.8%) and allergic conjunctivitis (n=1, 0.5%). Among 71 atopic patients, 59 patients (83.13 %) developed side effects to NAC. There was a relation between previous history of atopic disease and anaphylactoid reaction to NAC.
 Conclusions: We report substantially higher incidence of anaphylactoid reactions to IV-NAC than previous studies. Different atopic diseases must be considered as a risk factor in the development of side effects to IV-NAC-therapy.
 Keywords: Poisoning, Acetaminophen, Anaphylactoid reaction, N-acetylcysteine, Atopic diseas

Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery