Successful Suicide in a Child: Depression-Related or Paroxetine-Induced?

Background: Children and adolescents are prone to develop psychiatric problems after stressful life events. These problems need appropriate treatment because of negative consequences like disease-related suicide. Antidepressants (especially "Serotonin Selective Reuptake Inhibitors") are common treatments for psychiatric problems of children and adolescents; but different side effects, including drug-induced suicide, have been reported.Case Report: In this article, we describe a nine-year-old girl who developed depression after parental divorce and was prescribed paroxetine. During pharmacotherapy, she had suicidal thoughts and several unsuccessful attempts which have been neglected and finally last attempt was successful. This report is an evidence for physicians to prescribe antidepressants cautiously with reasonable indication. As still there is no certain contraindication of using antidepressants in pediatric patients, importance of follow-ups and screening of suicide in pediatric patients during treatment with antidepressants seems essential.Conclusion: This study discloses the magnitude of explaining the side effects of antidepressants to caregivers of children with psychiatric problems

Delayed Onset Brain Hypoxia and Subsequent Seizures: a Rare Fatal Consequence of Undiagnosed Foreign Body Aspiration

Background: Foreign body aspiration is a common medical emergency among children that can lead to lethal complications especially in neglected or misdiagnosed cases.Case Report: This article is a report of a 15-month-old child who aspirated food materials and after chocking crisis, she presented with unspecific respiratory symptoms and treated for respiratory tract infections. After five days, sudden airway obstruction led to hypoxic brain damage and seizure. Due to unavailability of bronchoscopic facilities, extraction of foreign body was postponed and persistent hypoxia led to irreversible brain damage, seizures and finally death. This report reveals the key role of physicians in prompt diagnosis and the importance of early extraction of aspirated foreign bodies, even in asymptomatic cases, to prevent later complications and related mortality and morbidity.Conclusion: This report contains warning hints for professionals in different fields of medicine that deal with pediatric patients

Generalized tonic colonic seizure followed by loss of consciousness early after using low dose of tramadol: A case report

Introduction: Despite high efficacy and safety of tramadol as a pain relieving analgesic, some minor side effects have been reported following its consumption. However, very rarely, serious and life-threatening side effects may appear following administration of tramadol. Case Presentation: This research describes a case of tramadol poisoning that appeared with acute seizure needing emergent and intensive cares. In the described case, using a low dose of tramadol (200 mg, orally), the patient experienced generalized tonic colonic seizure followed by loss of consciousness and shoulder dislocation due to trauma, requiring admission to the intensive care unit. Conclusions: As shown in the study, even using a low dose of tramadol might lead to acute generalized seizure with loss of consciousness and the need for intensive care. © 2018, Anesthesiology and Pain Medicine

Datura poisoning, clinical and laboratory findings. Report of five cases

Introduction. Plants of Datura species contain belladonna alkaloids that can cause central and peripheral anticholinergic effects. Abuse of Datura plants for their hallucinogenic effects is growing among adolescents and young adults. Datura poisoning has caused a diagnostic challenge in medical emergency wards. In this article we report 5 cases of Datura toxicity at Clinical Toxicology Emergency of Baharloo Hospital, Tehran, Iran during Summer-Fall 2015, and discuss their clinical presentations and laboratory findings. Cases. All 5 cases with Datura toxicity were young males and had intentionally used the plants. Mean duration of hospitalization was 3.2 days. Three cases were multiple-drug abusers. Mydriasis, tachycardia, tachypnea and flushing alongside with psychotic-like signs and symptoms were observed in all cases. Elevation of liver enzymes was present in three of cases but without clinical significance. Raised LDH or CPK in four patients were without myoglobinuria and evidence of rhabdomyolysis and these biomarkers returned to normal levels by supportive care. All patients discharged with complete recovery and there was no need to ICU admission. Discussion. With the absence of routine laboratory diagnostic tests for alkaloids and complex and confusing presentations of Datura intoxication, diagnosis of such cases is difficult. Physicians' clinical suspicion and sufficient knowledge play the mainstay roles in appropriate and timely diagnosis and management of cases with Datura toxicity. Since regulatory legislation wouldn�t be successful in halting the availability of natural plants, the best strategy to prevent Datura abuse is informing people about the adverse effects of these plants. © 2016 Romanian Society of Legal Medicine