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D Jacobsen

Publications and source records attributed to D Jacobsen.

At least 55 records · Page 3Linked to original sources
PubMed1996

4-Methylpyrazole (4-MP) is effectively removed by haemodialysis in the pig model.

The safety and pharmacokinetics of the alcohol dehydrogenase inhibitor 4-MP have recently been evaluated and its clinical use in ethylene glycol poisoning in France is promising. The dialysability of 4-MP is not known. This is important as hemodialysis is one of the cornerstones in the treatment of (late) ethylene glycol and methanol poisonings. We therefore studied the dialysability of 4-MP in the pig model. Anesthesized pigs (maintained on respirator) given 4-MP, 10 mg/kg, served as controls (n = 3) to the pigs (n = 3) given 15 mg/kg and hemodialyzed for 4 h. 4-MP plasma elimination curves for both groups were compared for 12 h and dialysance data calculated. 4-MP (MW 82) was removed by the same rate as urea (MW 60) by the 0.3 m2 dialysator, thus indicating no significant protein binding of 4-MP. The mean dialysance of 4-MP (and urea) in the three pigs were 61 (63), 51 (53) and 56 (48) ml/min, at a blood flow of 75 ml/min. The amount of 4-MP removed by hemodialysis in 4 h was 57-76 mg compared to a urinary excretion of 1-3 mg over 12 h. We conclude that the dialysability of 4-MP is significant and this must be taken into account when these two treatment procedures are combined.

Animals↗
PubMed1995

[Cocaine abuse and acute heart disease].

Cocaine abuse is an increasing problem in western societies, and health personnel should be aware of the cardiovascular effects of cocaine, of which myocardial infarction is the most frequent reported complication. Cardiac arrhythmia is another serious complication. We describe a young female who, after injecting cocaine intravenously, suffered from circulatory collapse, thought to represent an arrhythmia. The authors discuss the pharmacological and clinical aspects of cocaine-induced myocardial infarction and arrhythmias, and suggest guidelines for treatment.

Adult↗
PubMed1995

The relative efficacy of antidotes.

For many physicians an antidote is an antidote. According to the International Programme on Chemical Safety definition, an antidote is a therapeutic substance used to counteract the toxic action(s) of a specified xenobiotic. Given this wide definition, the efficacy of an antidote may vary considerably depending on which toxic action(s) being counteracted and the level of counteracting power. An almost 100% efficacy is seen using specific antagonists, such as naloxone in opiate poisoning or flumazenil in benzodiazepine poisoning, e.g. resulting in complete reversal of opiate toxicity unless complications, such as anoxic brain damage, have developed. At the other end of the efficacy scale, we may place chelating agents for heavy metal poisoning and diazepam for organophosphorus insecticide poisoning which are considered only to be an adjuncts to supportive care. When teaching clinical toxicology or recommending the use of antidotes in poisoned patients, the expected efficacy level of the antidote in question should be stressed. This may be particularly important in severe poisoning when the antidote may only be considered as an important adjunct to supportive care, e.g. deferoxamine in acute iron poisoning. Unless this is stressed, the unexperienced physician may rely too much on the antidote and pay insufficient attention to the supportive care. The varying efficacy levels will be discussed based on the presently ongoing International Programme on Chemical Safety/Commission of the European Communities evaluation program on antidotes.

Antidotes↗
PubMed1994

[Metabolic acidosis--a diagnostic challenge].

Metabolic acidosis can be caused by a variety of pathological conditions, but intoxication with ethylene glycol or methanol should be suspected in cases of a combined increase of osmolal and anion gaps. The determination of the gaps is based on readily available laboratory tests, and the results is known soon after the blood sample is taken. This procedure is of particular interest for hospitals where specific analyses for methanol and ethylene glycol are not available, since calculation of the gap can give an early indication of what treatment to use. Therefore, the gaps should be calculated as a routine in patients with metabolic acidosis of unknown origin. The authors describe the principles for calculating and using the gaps, and report three cases which illustrate their usefulness in practice.

Acidosis↗
PubMed1994

Osmolal and anion gaps in patients admitted to an emergency medical department.

1. Osmolal and anion gaps are helpful in the diagnosis and evaluation of intoxications with methanol and ethylene glycol. Reported reference values for osmolal gap and anion gap are -1 (+/- 6) mosm kg-1 H2O and 16 (+/- 2) mmol l-1, respectively. However, we have repeatedly found unexplained increased gaps in patients admitted to our department, and the relevance of the established reference values has been questioned. 2. Osmolal and anion gaps were determined in an unselected population of patients consecutively admitted to an emergency medical department. In the case of unexplained gaps, the blood samples were analysed with respect to the presence of alcohols and organic acids. 3. We included all accessible patients admitted during 14 days. Appropriate blood samples were obtained in 177 patients (88 male, 89 female), with a mean age of 65 years (range 17-94). 4. The mean and (standard deviation) for osmolal and anion gaps in our material were 5.2 mosm kg-1 H2O (7.0) and 12.9 mmol/l (4.2). Neither methanol nor ethylene-glycol was detected in serum from any patients. Small amounts of ethanol were found in 5 patients, and high lactate levels explained in part the most extensively increased anion gaps. However, the calculated analytical standard deviation accounted entirely for the variation in our material, and we suggest that the present reference values be adjusted.

Acid-Base Equilibrium↗
PubMed1994

Mortality and causes of death in a 10-year follow-up of patients treated for self-poisonings in Oslo.

The present 10-year follow-up study includes all patients (N = 926; 50% females) treated in the medical departments in Oslo for self-poisonings during one year (1980). Seventeen percent were considered suicidal attempts upon admission, 25% among the non-substance abusers and 8% among the abusers. At follow-up, 207 patients (22%) were dead (62% males). The mortality rate was highest among the abusers. The most common causes of death were suicide (21%), heart disease (17%), opiate abuse (15%), and accidents/wounds (13%). Forty-one percent of the suicides occurred during the first two years of the follow-up period. The suicides were by poisoning (57%), hanging (20%), and other methods (23%). The female mortality rate decreased in the second half of the follow-up period whereas the male rate did not change. The risk of death within 10 years after discharge increased with age and was higher in men and in abusers, whereas social group and motive for suicide were not predictive factors. The females had an excess suicide rate of 182 (36-327, 95% CI) in the first year after the self-poisoning and 61 (36-87, 95% CI) in the total period. The corresponding figures for males were 70 (19-122) and 21 (12-30). The only factor associated with an increased suicide rate was a suicidal motive upon the admission for self-poisoning with a 3.1 (1.7-5.8, 95% CI) times increased risk of suicide in the 10-year follow-up period.

Adolescent↗
PubMed1993

[Poisonings and gas accidents].

Recent trends in the treatment of acute poisoning, including exposure to gas, are briefly discussed. According to the new WHO/IPCS guidelines, a more restrictive use of gastric lavage and induction of emesis is recommended. Toxicokinetic evaluation of the efficacy of elimination procedures has lead to very few remaining indications for haemoperfusion, and forced acidic diuresis is no longer recommended.

Accidents↗
PubMed1993

Job analysis 1992: infection control practitioner.

The Certification Board of Infection Control directed its Research Subcommittee to compose a Job Analysis Committee in 1991. This 9-member Job Analysis Committee, in collaboration with Applied Measurement Professionals, Inc., conducted a job analysis of ICPs during 1992. The reassessment of the previous Certification Board of Infection Control task analysis, formation of a job-analysis survey tool, and the actual job-analysis process and its results are described in this article. The previous and newly revised test specification outlines are compared. The national Certification Examination for Infection Control for November 1993 will reflect the efforts of this endeavor.

Canada↗
PubMed1992

[Rhabdomyolysis in self-induced poisoning. A prospective study].

In a prospective study of 103 patients hospitalized for self-poisoning the incidence of rhabdomyolysis (creatine kinase > 1000 U/l) was nearly 7%. A further 9.7% had elevated creatine kinase activity, but lower than 1000 U/l. Two patients showed clinical symptoms of rhabdomyolysis at time of admission; one after heroin and the other after salicylate intoxication. Both developed renal failure, and one of them underwent peritoneal dialysis. The high incidence of rhabdomyolysis found in the study suggests that creatine kinase activity should be considered in all cases of intoxication admitted to hospital. Rhabdomyolysis may often present no symptoms even in conscious patients, and serious complications can be limited by preventive measures if rhabdomyolysis is recognized early.

Acute Kidney Injury↗
PubMed1992

The effect of cryopreservation on cell viability and hormone secretion in human parathyroid tissue.

BACKGROUND: To explain the decreased success of cryopreserved versus fresh parathyroid autotransplants, we investigated the effect of cryopreservation on parathyroid function. METHODS: Parathyroid cryopreserved tissue from surgical specimens of 18 patients was analyzed in a comparative fashion with 10 fresh abnormal glands. Cell viability was evaluated by a double-fluorescence technique, and parathyroid hormone secretion was detected from individually dispersed parathyroid cells with the reverse hemolytic plaque assay. The plaque area reflected the amount of parathyroid hormone secreted by each cell, and the percentage of plaque-forming cells represented the number of secreting cells. Feedback regulatory mechanisms remained intact for both fresh and cryopreserved tissue as shown over a wide range of calcium concentrations. RESULTS: The percentage of viable cells from fresh and cryopreserved tissue was always in excess of 88%. No significant difference was noted in the percentage of plaque-forming cells nor the amount of hormone released per individual cell comparing fresh and cryopreserved glands (6 months to 2 years). Specifically, at physiologic calcium concentrations no significant differences existed in the secretory behavior between fresh and cryopreserved tissue. CONCLUSIONS: Without showing decreased viability or parathyroid hormone secretion after cryopreservation, the cause of graft failure in cryopreserved tissue still remains unknown.

Calcium↗
PubMed1991

Rapid identification of respiratory syncytial virus infections by direct fluorescent antibody testing: reliability as a guide to patient cohorting.

This study compared the results of a commercially available, direct fluorescent antibody (DFA) test with viral culture in 880 specimens obtained from 690 patients by means of nasopharyngeal swabs. The two tests were congruent in 92.5% (814) of the specimens. The sensitivity of the DFA was 0.95, the specificity was 0.91, the positive predictive value was 0.82, and the negative predictive value was 0.98. Among 548 inpatients, there were 3 mixed infections (RSV and another virus), 8 RSV infections not identified by the DFA, and 35 positive DFA results not confirmed by cell culture. Use of the DFA test alone would have resulted in 502 (92%) correct patient-placement decisions. We conclude that the DFA test provides reliable evidence on which to base patient-placement decisions but that the error rate is too high to permit safe cohorting of high-risk patients, such as those with bronchopulmonary dysplasia.

Adolescent↗
PubMed1991

Suicide and other causes of death in a five-year follow-up of patients treated for self-poisoning in Oslo.

This 5-year follow-up study includes all patients (n = 934; 50% females) treated for self-poisoning in Oslo during 1 year. Seventeen percent were considered suicide attempts upon admission, 25% among the nonabusers and 8% among the abusers. At follow-up, 122 patients were dead (61% males). The mortality rate was highest among the abusers. The mortality rate was similar (13%) among those who were considered to be suicidal on admittance and those who were not. The causes of death were suicide (28%), opiate abuse (16%), heart disease (14%), accidents or wounds (11%), alcoholism (9%) and others (22%). The standard mortality rate was highly increased in all groups (8 times on average), highest among the female opiate abusers, whose rate was 63 times higher than expected. The increased suicide rates (87 times for females, 27 times for males), however, may be a more relevant measure of mental morbidity than the standard mortality rate. Logistic regression analysis demonstrated that male sex, age above 50 years and the lowest social group were factors on admission associated with death in the follow-up period. Age above 50 years and suicidal attempt on admission were associated with subsequent suicide. The study strongly supports the idea of self-destructiveness and slow suicide in substance abuse.

Adult↗
PubMed1990

[Organophosphate poisoning].

Three cases of poisoning by organophosphate dimethoate are described and the importance of correct diagnosis and adequate treatment emphasized. Therapy consists of large doses of atropine, to counteract the muscarinic and other effects on the central nervous system, followed by a reactivator (e.g. toxogonin) to reverse muscle weakness (nicotinic effects).

Aged↗
PubMed1990

Morphine-6-glucuronide might mediate the prolonged opioid effect of morphine in acute renal failure.

1. A 43-year-old male developed acute kidney failure due to ethylene glycol poisoning. He was treated with bicarbonate to combat metabolic acidosis, ethanol as an antimetabolite and haemodialysis to remove the glycol and its toxic metabolites. He was kept on a respirator and sedated with morphine. Peritoneal dialysis was given for 36 d. Following sedation with morphine for 11 d, the patient was given naloxone and then extubated. The antidote had to be continued for 14 d to prevent respiratory depression, until kidney function improved. 2. Only morphine-6-glucuronide (M-6-G) was found in the plasma and CSF at concentrations which might explain the opioid effects observed in the patient during the days after the cessation of morphine treatment. The ratio of the area under the concentration-time curve (AUC) of morphine-3-glucuronide (M-3-G) to M-6-G was 2:1. The elimination half-lives of M-3-G and M-6-G were 55 and 82 h, respectively. The clearance data indicate that most of the glucuronides were eliminated by peritoneal dialysis during renal failure. 3. The data suggest that M-6-G exerts opioid effects and is retained in acute kidney failure. Morphine should therefore not be used preferentially as a sedative/analgesic in pronounced kidney failure.

Acute Kidney Injury↗