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Biomedical subjects

Dag Jacobsen

Publications and source records attributed to Dag Jacobsen.

At least 19 recordsLinked to original sources
PubMed2006

[Paracetamol poisoning--occurrence and treatment].

BACKGROUND: Poisoning with paracetamol is common and potentially serious. We have assessed the incidence of paracetamol poisoning and the hospital's use of serum analyses to monitor the antidotal treatment N-acetyl cysteine. MATERIAL AND METHODS: All hospital records of ICD-10 diagnoses T4n and T50.9 at the Department of Acute Medicine from July 2001 to July 2004, were retrospectively reviewed. All cases with possible or confirmed paracetamol poisoning were recorded. Liver damage was defined as ALT above 1,000 U/l. Standard European treatment nomogram was used. RESULTS: Of 869 admissions with acute poisoning, 158 (21%) were caused by paracetamol; of these 120 (76%) were women and 38 (24%) were men. 107 (68%) of the patients were treated with N-acetyl cysteine at admission due to suspected ingestion of more than 10 grams of paracetamol. Treatment was abrupted in 84 (79%) of the patients, as levels of serum paracetamol were below the treatment line in the nomogram. The median time from admission to sampling was 5 hours. Nine patients (6%), who all arrived later than 15 hours after ingesting paracetamol, developed liver damage. One woman died after a sub-acute overdose of paracetamol. INTERPRETATION: Few patients needed treatment with antidote. The treatment seemed to protect all against liver damage if started early. Liver damage and death was associated with admission later than 15 hours after intake.

Acetaminophen↗
PubMed2006

Determination of prognosis after cardiac arrest may be more difficult after introduction of therapeutic hypothermia.

A 50-year-old patient had status epilepticus and no adequate reactions nine days after prolonged out-of-hospital cardiac arrest. The cause of the arrest was acute myocardial infarction which was treated successfully with percutaneous cardiac intervention (PCI) and a stent placement. He was treated with therapeutic hypothermia (33 degrees C) for 24h and in intensive care with respiratory support for 42 days. One year later he has fully recovered and is back to normal life and academic work. The previously reported 100% prognosis of a poor neurological outcome in the presence of seizures 72 h post arrest may need to be re-examined after introduction of therapeutic hypothermia.

Heart Arrest↗
PubMed2006

Use of the osmolal gap to guide the start and duration of dialysis in methanol poisoning.

OBJECTIVE: Rapid diagnosis and treatment of methanol poisoning is mandatory. Dependence on serum methanol analysis in this situation may delay diagnosis and treatment. The anion and osmolal gaps have been recommended for use as diagnostic tools, but the use of these gaps to evaluate the length of hemodialysis treatment has only been emphasized in a few reports. We evaluated the usefulness of the osmolal gap in estimating the need for dialysis and the duration of this treatment in 17 methanol-poisoned subjects. MATERIAL AND METHODS: Patients were part of a recent outbreak of methanol poisoning, in which the diagnosis upon admission was mainly based on use of the anion and osmolal gaps. The duration of dialysis generally followed the standard recommendation of 8h. During dialysis, blood samples were frequently collected and analyzed to determine acid-base status and serum methanol and to calculate the osmolal gap. In nine patients, the duration of dialysis was compared with the duration necessary to normalize serum methanol and the osmolal gap. RESULTS: There was a good correlation between serum methanol and the osmolal gap during hemodialysis (y=1.09x+3.82; R(2)=0.92). The osmolal gap therefore gives a good estimate of the serum methanol level during hemodialysis, and could have saved a total of 23 h of dialysis treatment (34%) in nine patients had it been applied. CONCLUSIONS: In the absence of serum methanol analyses, the osmolal gap is useful to assess the indication for and duration of hemodialysis in methanol-poisoned patients. In mass poisoning situations, use of the osmolal gap makes it possible to reduce the duration of dialysis in a safe manner.

Acid-Base Equilibrium↗
PubMed2005

[Ingested lead cartridges cause trouble].

BACKGROUND: Lead poisoning is rare. Intake of lead shots may cause damage of the bone marrow, the nervous system, the liver, the kidneys and the endocrine organs. MATERIALS AND METHODS: We present two patients who had taken approximately 120 grams of lead shots. They developed asthenia, nausea and abdominal pain. We tried to remove the lead shots with fluids, laxatives and colonoscopy, but ultimately surgical intervention had to be performed. The patients were also treated with dimercaptosuccinic acid (DMSA). RESULTS AND INTERPRETATION: Although DMSA treatment is associated with a significant decrease in blood lead concentration and an increase of lead urinary excretion, surgical intervention is the most efficient way of treating oral intake of lead. Treatment with DMSA will probably have to go on for months in order to give an additional effect.

Adult↗
PubMed2005

[Nerve gas--guidelines for care of victims of terrorism].

The threat from chemical warfare agents such as nerve agents against civilians has traditionally been considered irrelevant. Following the recent terrorist attacks in the US on 11 September 2001 and in Madrid, Spain on 11 March 2004, the threat from such weapons is taken seriously. Hospitals must therefore be prepared to take care of civilian victims. Emergency preparedness implies education and training of healthcare professionals, stocking of antidotes, and training of personnel. This involves decontamination of patients, establishment of routines to avoid contamination of hospitals, and the ability to determine if patients and first responders are contaminated with chemicals and to avoid such contamination. Treatment against nerve agents includes atropine, acetylcholinesterase reactivators (obidoxime or pralidoxime) and benzodiazepines (diazepam). Because these drugs are not sufficiently effective in protecting the brain, new and more effective countermeasures must be developed.

Antidotes↗
PubMed2005

Carisoprodol intoxications and serotonergic features.

The symptoms and signs of carisoprodol intoxications do not resemble those caused by its metabolite meprobamate. Meprobamate most probably produces its effects through the GABAergic neurotransmitter system. The signs and symptoms of carisoprodol intoxications, however, are not easily explained by interaction with this neurotransmitter system. In the present study, four cases of carisoprodol intoxications are presented with emphasis on the presence of serotonergic signs and symptoms. All four cases fulfilled three different sets of criteria for the diagnosis of serotonin syndrome. These findings could indicate that an increased serotonin level in the central nervous system could explain some of the symptoms and signs of carisoprodol intoxications. This may have implications for the clinical evaluation and treatment of such intoxications. Since few laboratories routinely screen for carisoprodol it is important to keep this drug in mind when encountering intoxications displaying serotonergic symptoms.

Adult↗
PubMed2005

Increased serum formate in the diagnosis of methanol poisoning.

Early diagnosis is essential for successful treatment in methanol poisoning. Methanol detection by gas chromatography is not available in most hospitals. Methanol increases the osmolal gap in serum and its metabolite formate increases the anion gap. The sensitivity of these indirect diagnostic methods is not good at low concentrations of methanol or formate. We therefore studied the usefulness of formate measurement in diagnosing methanol poisoning. In 15 patients poisoned with methanol, serum formate was measured enzymatically on a Cobas Mira analyzer using formate dehydrogenase and nicotinamid adenine dinucleotid. Day-to-day coefficient of variation was 5%, and the upper reference limit was 2 mg/dL (0.4 mmol/L). Methanol was detected in all 15 patients of whom 14 had elevated serum formate concentrations. Anion gap was increased in 11 of 11, and osmolal gap in 11 patients of 15 examined. Metabolic acidosis was present in 12 of 15 patients, but pH was below 7.30 in only 9 of them. Four patients with no symptoms had formate concentrations in the range 2-38 mg/dL (0.5-8.3 mmol/L), indicating that increased serum formate was a sensitive indicator of methanol poisoning. Our results proved formate analyzes to be a simple, sensitive, and specific way of diagnosing methanol poisoning. Confounders are patients admitted early, or concomitant ethanol ingestion, and therefore no acidosis. This problem may, however, be omitted by repeated formate analysis in patients developing metabolic acidosis.

Adult↗
PubMed2005

Methanol and formate kinetics during treatment with fomepizole.

OBJECTIVE: Methanol is metabolized by alcohol dehydrogenase to formaldehyde, and further to formic acid, which is responsible for the toxicity in methanol poisoning. Fomepizole (4-methylpyrazole) is a potent competitive inhibitor of alcohol dehydrogenase and is used as an antidote to treat methanol poisonings. We report serum methanol kinetics in eight patients treated with bicarbonate and fomepizole only. METHODS: Prospective case series study of eight patients with methanol poisoning, who were selected to fomepizole and bicarbonate treatment only, because of moderate metabolic acidosis. Three of the patients were later dialyzed, because of high serum methanol concentrations and very slow methanol elimination. RESULTS: Upon admission the median pH was 7.27 (range 7.12-7.50), median base deficit was 15 mmol/L (5-22 mmol/L) and median serum methanol was 20.4 mmol/L (65 mg/dL) (range 8.4-140.6 mmol/L). The kinetics of methanol during fomepizole treatment in six patients was best described by a first-order elimination one-compartment model. The mean correlation coefficient (R2) describing the first-order elimination model in all eight patients was 0.95 (range 0.90-0.99). The mean plasma half-life (t(1/2)) of methanol during fomepizole treatment was 52 h (range 22-87); the higher the serum methanol, the longer the T(1/2). Mean half-life of serum formate was 2.6 h, when methanol metabolism was assumed blocked by fomepizole and no folinic acid was given. This rapid formate elimination in nonacidotic patients may be explained by high renal excretion of formate. CONCLUSION: Based on our data, methanol-poisoned patients with moderate metabolic acidosis and methanol levels up to 19 mmol/L (60 mg/L) may safely be treated with bicarbonate and fomepizole only, without dialysis.

Acidosis↗
PubMed2004

[Methanol poisoning in Norway 2002].

BACKGROUND: In Norway methanol poisoning is rare. During the last four months of 2002, smuggled spirits containing about 20% methanol was distributed and ingested. MATERIAL AND METHODS: Epidemiological and clinical data concerning 33 patients admitted to hospital with methanol poisoning are presented. RESULTS: After a latency period of 12 to 72 hours, clinical features developed; visual disturbances and dyspnoea were particularly common. Diagnosis was based upon the anamnesis and clinical and laboratory findings. Calculation of anion gaps and osmolal gaps, were important diagnostic tools. Fomepizole was used as an antidote in 23 cases; 24 were dialysed. 28 patients were discharged, four of whom with permanent visual disturbances and signs of cerebral damage. Hospital mortality was 15% (five patients); eight patients died outside hospital with a post-mortem diagnosis of methanol poisoning. INTERPRETATION: Rapid diagnosis and treatment is mandatory in cases of methanol poisoning. The mixture of 20% methanol in ethanol resulted in a temporary block of methanol metabolism. The latency period therefore increased, leading to diagnostic problems.

Adult↗
PubMed2004

[Diagnosis in metabolic acidosis of unknown origin].

BACKGROUND: Obtaining a precise diagnosis in patients presenting with metabolic acidosis of unknown origin is difficult. Poisoning with methanol or ethylene glycol should be suspected in cases with a combined increase of osmolal and anion gaps. MATERIALS AND METHODS: Retrospectively we have compared the methanol and ethylene glycol values in poisoned patients with their osmolal gaps. The anion gaps are compared to the toxic anions measured. RESULTS: There were good correlations between serum alcohols and osmolal gaps and between toxic metabolites and anion gaps. INTERPRETATION: The osmolal and the anion gaps are both helpful tools in the diagnosis of patients with metabolic acidosis of unknown origin, especially for identifying patients poisoned with methanol or ethylene glycol.

Acidosis↗
PubMed2004

[A 25-year old woman with abdominal pain and respiratory failure].

BACKGROUND: About 25% of patients with acute pancreatitis progress into severe pancreatitis with local and systemic complications. Local complications include oedema, necrosis, haemorrhage, infections, abscesses and pseudocysts. Systemic complications frequently involve the lungs and the kidneys in addition to cardiovascular dysfunction with hypotension and shock. Multi-organ failure is caused by a systemic inflammatory response commonly seen in necrotising pancreatitis, a severe condition with high mortality (about 30%). Similar pathogenesis is seen in sepsis or severe burns. METHODS: We report a young woman with acute pancreatitis and have used available literature to discuss the clinical picture and the pathogenesis, with an emphasis on the systemic complications. RESULTS AND INTERPRETATION: Systemic complications like multi-organ failure are frequently reported in acute severe pancreatitis characterised by pancreatic oedema and necrosis. Our patient had abdominal pain and mild pancreatitis without radiological manifestations. She developed systemic complications with respiratory failure not previously reported in mild pancreatitis. Early identification of systemic complications in acute pancreatitis is important in order to start treatment and reduce the risk of a fatal outcome.

Abdominal Pain↗
PubMed2004

Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients.

OBJECTIVE: To evaluate anion and osmolal gaps as diagnostic tools in methanol poisoning. DESIGN AND SETTING: Clinical observational study. PATIENTS AND METHODS: In a recent methanol outbreak, the initial triage and treatment decisions in 28 patients were based mainly upon the values of the osmolal and anion gaps on admission. Methanol and formate levels were later compared to these gaps by linear regression analysis. RESULTS: The correlation between the osmolal gaps and serum methanol concentrations on admission was linear (y = 1.03x+12.71, R2 = 0.94). The anion gaps correlated well with the serum formate concentrations (y = 1.12x+13.82, R2 = 0.86). Both gaps were elevated in 24 of the 28 subjects upon admission. Three patients had an osmolal gap within the reference area (because of low serum methanol), but elevated anion gap because of formate accumulation. One patient with probable concomitant ethanol ingestion had a high osmolal gap and a normal anion gap. CONCLUSION: Osmolal and anion gaps are useful in the diagnosis and triage of methanol-exposed subjects. Confounders are low serum methanol and concomitant ethanol ingestion.

Acid-Base Equilibrium↗
PubMed2004

[Smuggling of illegal drugs by body suffers].

BACKGROUND: Body packers are persons who smuggle illegal drugs by swallowing condoms or plastic cylinders containing such substances. Body stuffers are drug dealers or drug abusers who swallow illegal drugs in an effort to conceal evidence during an arrest or in fear of being arrested. MATERIAL AND METHODS: We report four cases and discuss management. RESULTS AND INTERPRETATION: Asymptomatic body packers may be managed conservatively with laxatives and water-soluble contrast medium. This method allows an accurate follow-up with abdominal radiography. If patients develop abdominal pain or signs and symptoms of intoxication, surgical intervention should be considered. Both types of patients should be monitored carefully.

Adult↗
PubMed2004

[Adder bites in Norway--occurrence and treatment].

BACKGROUND: Adder bites rarely cause severe reactions and when they occur there are specific antivenoms with few side effects that may be used in addition to supportive therapy. The antivenom is manufactured from sheep and consists of Fab fragments. MATERIAL AND METHODS: Between 1998 and 2002 there were 245 registered calls regarding adder bites to the Norwegian National Poisons Information Centre. We present three patients with adder bites treated with antivenom. RESULTS AND INTERPRETATIONS: The National Poisons Information Centre had 245 inquiries about adder bites over a five-year period. In 12% of cases the risk of intoxication was considered to be non-existent. Risk of or established mild to moderate reactions were found in 67%; 13% were considered to be in danger of severe reactions; the remaining 8% were unclassified. In severe adder bites, antivenom therapy has documented effect.

Adolescent↗
PubMed2004

[Therapeutic hypothermia after cardiac arrest saves more lives!].

To treat patients suffering from cardiac arrest after restoration of spontaneous circulation has been difficult and discouraging, with a high mortality rate. Two independent studies have, however, shown that early treatment with hypothermia increases survival and protects from neurological sequelae after out-of-hospital cardiac arrest. Recently the International Liaison Committee on Resuscitation (ILCOR) has published an advisory statement recommending therapeutic hypothermia after out-of-hospital cardiac arrest. In this paper the issue is discussed and the therapy recommended.

Cardiopulmonary Resuscitation↗
PubMed2004

[Severe sepsis treated with activated protein C].

BACKGROUND: Severe sepsis is a common cause of mortality in critically ill patients. Drotrecogin alfa (activated), synonymous with recombinant human activated protein C (rhAPC), is a new therapeutic tool with anticoagulant, anti-inflammatory and profibrinolytic properties with proven effect in reducing mortality in severe sepsis. MATERIAL AND METHODS: As part of a multi-centre study, the patients received an infusion of rhAPC, 24 microg/kg/h for 96 hours according to an open-labeled phase IIIb study protocol. RESULTS: Out of a total of 28 patients, 6 (21%) died before day 28. One of the deaths was classified as possibly related to rhAPC. In three patients rhAPC was transiently stopped because of surgery or postoperative bleeding. Use of the compound rarely interfered with commonly used diagnostic and therapeutic procedures. INTERPRETATION: Treatment with rhAPC is easily carried out in an intensive care unit. Patients with severe sepsis and two or more failing vital organs should be considered for treatment with rhAPC.

Adult↗
PubMed2004

Adverse events after naloxone treatment of episodes of suspected acute opioid overdose.

OBJECTIVE: An increasing and serious heroin overdose problem in Oslo has mandated the increasing out-of-hospital use of naloxone administered by paramedics. The aim of this study was to determine the frequencies and characteristics of adverse events related to this out-of-hospital administration by paramedics. METHODS: A one-year prospective observational study from February 1998 to January 1999 was performed in patients suspected to be acutely overdosed by an opioid. A total of 1192 episodes treated with naloxone administered by the Emergency Medical Service system in Oslo, were included. The main outcome variable was adverse events observed immediately after the administration of naloxone. RESULTS: The mean age of patients included was 32.6 years, and 77% were men. Adverse events suspected to be related to naloxone treatment were reported in 45% of episodes. The most common adverse events were related to opioid withdrawal (33%) such as gastrointestinal disorders, aggressiveness, tachycardia, shivering, sweating and tremor. Cases of confusion/restlessness (32%) might be related either to opioid withdrawal or to the effect of the heroin in combination with other drugs. Headache and seizures (25%) were probably related to hypoxia. Most events were non-serious. In three episodes (0.3%) the patients were hospitalized because of adverse events. CONCLUSION: Although adverse events were common among patients treated for opioid overdose in an out-of-hospital setting, serious complications were rare. Out-of-hospital naloxone treatment by paramedics seems to save several lives a year without a high risk of serious complications.

Acute Disease↗