Biomedical subjects

B J Noel

Publications and source records attributed to B J Noel.

5 recordsLinked to original sources

PubMed1979

Self-poisoning with over-the-counter hypnotics.

Over-the-counter (OTC) hypnotic preparations (such as Sominex, Nytol, and Sleep Eze) were implicated in 21 of the 773 admissions to Massachusetts General Hospital due to psychotropic drug overdosage between 1962 and 1975. Ten of the 21 cases had manifestations of central anticholinergic toxicity ("atropine-like psychosis"), such as hallucinations, delirium, and confusion. However, all patients recovered rapidly and without sequelae. Specific therapy (i.e., physostigmine) was rarely required. Thus OTC hypnotic overdosage commonly produces "toxic psychosis." Fortunately, intoxication is usually of short duration and relatively benign.

Adolescent↗

PubMed1979

Correlates of outcome following acute glutethimide overdosage.

Potential predictors of outcome following acute glutethimide overdosage were assessed in 63 patients hospitalized with this diagnosis at a large urban medical center between 1962 and 1975. Their mean age was 34 years (range, 15 to 84 years) and 62% were female. Assisted ventilation was required in 59% of cases, and 32% developed hypotension. Six patients died, including all three aged 60 years or older. Multiple regression analysis confirmed that age was the major identifiable determinant of survival, regardless of other factors. Among identifiable determinants of coma grade, glutethimide dose, glutethimide plasma concentration, and coingestion of barbiturates were the most important. An ingested dose of 10 g or more, or a plasma concentration exceeding 30 microgram/ml, was almost always associated with deep coma. However, a relatively small ingested dose or a low plasma level by no means ruled out development of serious intoxication, particularly in those patients who also ingested barbiturates. Thus elderly individuals are at high risk for fatal outcome following glutethimide overdosage and should receive priority for intensive care and monitoring. Glutethimide dose, plasma concentration, and history of coingestion of barbiturates are of value in predicting development of deep coma. These items of information should be obtained on admission whenever possible.

Adolescent↗

PubMed1977

Acute overdosage with benzodiazepine derivatives.

A total of 773 admissions to Massachusetts General Hospital between 1962 and 1975 were due to acute overdosage with one or more psychotropic drugs. Benzodiazepine overdosage, particularly with diazepam, increased relative to other psychotropic drugs over the years. Only 12 admissions were due to benzodiazepine overdosage alone, and none of these patients were seriously ill or had significant complications. Multiple drugs were ingested in the other 87 cases, and the frequency and severity of complications among these individuals depended upon the type and quantity of other nonbenzodiazepines taken. For example, 21 of 31 patients who ingested benzodiazepines together with barbiturates experienced severe central nervous system (CNS) depression, and 14 of 31 required assisted ventilation. However, the frequency of such complications was nearly identical in a group of patients who ingested barbiturates alone. This report and a review of the literature suggest that serious intoxication following overdosage with a benzodiazepine derivative alone is unusual. Ingestion of benzodiazepines together with other drugs appears to be considerably more common than benzodiazepine overdosage alone as a cause of intoxication. The severity of intoxication in such cases of multiple drug ingestion probably depends largely on the type and quantity of nonbenzodiazepines.

Adolescent↗

PubMed1977

Meprobamate overdosage: a continuing problem.

Meprobamate was implicated in 50 (6.5%) of 773 admissions to Massachusetts General Hospital due to psychotropic drug overdosage between 1962 and 1975. Estimated doses ingested reached as high as 40 gm. Serious intoxication was common. In 25 cases deep coma (grade 3 or 4) was reached; 23 patients became hypotensive, and 16 required assisted ventilation. Two patients died, one of whom ingested an estimated 12 to 20 gm of meprobamate apparently with no other drugs. The findings indicate that overdosage with meprobamate, even when taken alone, produces intoxication that is often serious and sometimes fatal. Although meprobamate is a relatively inexpensive anti-anxiety agent, its questionable efficacy and the potential for life-threatening intoxication are important drawbacks to the clinical use of this drug.

Adolescent↗

PubMedDate not supplied

Overdosage with pentobarbital and secobarbital: assessment of factors related to outcome.

Factors related to clinical outcome following acute overdosage with pentobarbital or secobarbital were assessed in a series of 162 patients hospitalized during the period 1962 to 1975. The mean ingested dose was 2 Gm (range 0.2 to 10.0 Gm), and plasma barbiturate concentrations ranged from 2.0 to 72.0 microgram/ml. Serious intoxication was common. Intubation and assisted ventilation were required in 59 per cent of patients, and 23 per cent developed clinically important hypotension. Four patients died, all relatively young females. Multiple regression and discriminant function analyses, performed on a subset of 88 patients for whom complete data were available, indicated that plasma barbiturate concentration and/or ingested dose were the most important correlates of serious intoxication among identifiable variables available on admission. Coingestion of other central nervous system depressants, such as ethanol, had no obvious effect on outcome. The present study suggests that measurement of plasma barbiturate concentrations is of value in identifying patients at risk of developing serious intoxication after overdosage with pentobarbital or secobarbital.

Adolescent↗