Alumi piktnaudžiaujančio vyro vartojamo hidrochlorotiazido sukeltos sunkios hiponatremijos diagnostika ir gydymas

Introduction: Beer potomania is a syndrome of severe hyponatremia caused by excessive beer consumption. The risk of hyponatremia increases in the case of a combination of beer potomania and the use of thiazide diuretics. Case report: A 55-year-old male patient with the anamnesis of a long-lasting alcohol use disorder was presented to the emergency department after seizures accompanied by an impaired mental status. He had been drinking beer regularly for ten years. On physical examination, the patient was tachypneic, tachycardic, disorientated, restless, the Glasgow Coma Scale score of 9, observed tremor, and the smell of alcohol from the mouth. Laboratory results showed plasma sodium 105 mmol/L, blood urea nitrogen 1.8 mmol/L, the alcohol concentration in the blood 0.06 g/l, and calculated serum osmolality 219 mOsm/kg H2O. After a detailed initial evaluation of the patient and labs for hyponatremia, a diagnosis of beer potomania was established. On the third day of hospitalization, the patient's anamnesis was filled with information about the use of Valsartan/hydrochlorothiazide, together with reduced salt intake in the diet for three months for arterial hypertension treatment. It was decided that the combination of heavy beer drinking with the use of diuretic and reduced consumption of salt provoked hyponatremia. The patient was treated with infusion therapy of sodium chloride; plasma sodium level reached 136 on the third day of treatment. Conclusions: This case represents an unusual syndrome of beer potomania in conjunction with hydrochlorothiazide usage and reduced salt consumption, which can result in severe hyponatremia that may provoke severe neurologic damage

Narrative literature review of potential atrial fibrillation mechanism of action induced by discontinuation of benzodiazepines /

Introduction: Benzodiazepines are commonly prescribed but often misused, leading to dependence and withdrawal symptoms. Increased worldwide prescriptions raise adverse effects and overdose concerns, especially for the elderly. Caution is needed in prescribing and considering alternative treatments to minimize risks. Aim: Narrative literature review of potential atrial fibrillation mechanism of action induced by discontinuation of benzodiazepines. Materials and methods: Database PubMed was searched using the combination of keywords – “Benzodiazepine AND atrial fibrillation OR peripheral benzodiazepine receptors”, “history of benzodiazepines”, “benzodiazepines mechanism of action”, “benzodiazepines indications”, “benzodiazepines adverse effects” and “benzodiazepines withdrawal effects”. Non-full-text and non-English scientific publications were removed. A total of 31 publication was included. Discussion: Benzodiazepines (BZDs) were synthesized in 1955 and initially considered less toxic than barbiturates. They interact with GABA-A receptors, causing hyperpolarization and inhibitory effects in the central nervous system. BZDs are used to treat various clinical disorders, but long-term use can lead to adverse effects and withdrawal symptoms. There is evidence that genetic diversity can influence the response to BZDs through GABA receptors. The interaction between benzodiazepines and peripheral benzodiazepine receptors may influence calcium ion channels, affecting cardiac action potential and contractility, and discontinuation of these medications can potentially contribute to atrial fibrillation. Additionally, benzodiazepines may directly affect calcium channels, causing antiarrhythmic effects and vasodilation. Conclusion: In summary, benzodiazepines, once considered safer sedatives, now raise concerns about misuse, dependence, and withdrawal symptoms. While there is a potential link between discontinuing benzodiazepines and atrial fibrillation through mechanisms involving peripheral benzodiazepine receptors and cardiac calcium channels, causality remains uncertain and multifaceted. Further research is needed to clarify these mechanisms, and healthcare providers should exercise caution in long-term benzodiazepine prescriptions while exploring alternative treatment strategies to mitigate risks

Profile of patients presenting with acute seizures: is alcohol-related seizures a big problem in Lithuania?

Purpose: The goal of the study is to determine the proportion of alcohol-related seizures (ARS) among acute onset seizure patients, and to assess the results within the context of previous studies. The secondary goal of the study is to compare the characteristics and lab test results between ARS and non-ARS subgroup. Method: We retrospectively evaluated demographical, laboratory and clinical data of 550 patients who have suffered an acute onset seizure and were admitted to the emergency department of Republican Vilnius University Hospital (RVUH) in Lithuania between February 2019 and October 2019. Results: A total of 273 (49,6%) cases of seizures were determined to be alcohol-related, 201 (73,6%) of which had an ICD-10-AM codes F10 or T51.0 attributed to them. Medical records of 72 (26.4%) patients were significant for history of alcohol abuse. The majority (84,2% vs 57,2%, p = 0,001) of the ARS patients were male, they have suffered more frequently from new-onset seizures (31,5% vs. 21,3%, p = 0,007) and more commonly presented with tongue biting (20,9% vs. 7,9%, p < 0,001) compared to non-ARS patients. Patients in ARS subgroup had a less pronounced neurological disease profile (brain tumours 0,4% vs 8,3; stroke 1,1% vs 14,38%; p = 0,001), but more often suffered from alcohol-related liver disease (ARLD), compared to non-ARS patients (11,4% vs. 1,4%; P < 0,001). Conclusion: ARS is a big problem in Lithuania, while approximately half of the patients had seizures related with alcohol abuse

Seizures as a complication of recreational drug use: Analysis of the Euro-DEN Plus data-set

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MDMA-related presentations to the emergency departments of the European Drug Emergencies Network plus (Euro-DEN Plus) over the four-year period 2014–2017

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Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

International audienceFollowing the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate <12 breaths/min. These presentations potentially pose a significant burden on emergency departments with a large proportion requiring admission to hospital for ongoing care

Novel psychoactive substances-related presentations to the emergency departments of the European drug emergencies network plus (Euro-DEN plus) over the six-year period 2014–2019

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