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Biomedical subjects

G A Grande

Publications and source records attributed to G A Grande.

8 recordsLinked to original sources
PubMed1994

A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose.

STUDY OBJECTIVE: To evaluate whether activated charcoal (AC) reduces the efficacy of subsequent oral N-acetylcysteine therapy during acute acetaminophen overdose. DESIGN: Prospective observational case series of all acute acetaminophen overdoses reported to three certified regional poison centers. TYPES OF PATIENTS: All patients with acute acetaminophen overdose in whom N-acetylcysteine therapy was initiated within 16 hours after ingestion. INTERVENTIONS: All patients were treated with oral N-acetylcysteine therapy for 72 hours. The decision to use AC was left to the treating physician without input from the investigator. MEASUREMENTS AND RESULTS: One hundred twenty-two patients were evaluated. Maximum recorded SGOT levels of more than 125 U/mL were defined as evidence of hepatotoxicity. AC was used in addition to N-acetylcysteine in 82 of 122 patients. Hepatotoxicity developed in four of 82 patients who received AC versus ten of 40 patients who did not receive AC (P < .005). An increasing dose of N-acetylcysteine provided no additional benefit (P > .05). Spacing the administration of AC and oral N-acetylcysteine less than or more than two hours apart did not affect outcome (P > .05). CONCLUSION: Administration of AC before the administration of oral N-acetylcysteine in acetaminophen overdose does not reduce the efficacy of N-acetylcysteine therapy and may provide some additional hepatoprotective benefit. The practice of increasing the dose of oral N-acetylcysteine therapy after the administration of AC appears unwarranted.

Acetaminophen↗
PubMed1992

Survival following hydrofluoric acid ingestion.

Systemic toxicity after significant dermal exposure to hydrofluoric acid includes rapid development of hypocalcemia and hyperkalemia, leading to ventricular fibrillation. Similar dysrhythmias have occurred in patients after ingestion of sodium fluoride-containing compounds. Ingestion of hydrofluoric acid could induce similar cardiac toxicity; however, reported cases of hydrofluoric acid ingestion rarely have been described, and the rapid death of these patients has not allowed verification of this hypothesis. On two separate occasions, a 70-year-old woman ingested up to 2 oz of a 8% hydrofluoric acid-containing solution. Recurrent ventricular fibrillation with concurrent hypocalcemia and hypomagnesemia complicated her first episode, whereas a more aggressive administration of calcium and magnesium may have prevented dysrhythmias in the second episode. Survival from ventricular fibrillation after hydrofluoric acid ingestion has not been reported previously and suggests a role for aggressive empiric calcium and magnesium replacement.

Aged↗
PubMed1990

How serious is the radon problem?

In the last year or two, a vast array of radon-detection kits has appeared in stores and catalogs. The authors explain what radon is and why it has captured the interest of the American public. They also examine the extent and significance of the radon problem and suggest solutions for homes that are found to have a high concentration.

Humans↗
PubMed1987

The effect of fluid volume on syrup of ipecac emesis time.

Large volumes of fluid have been recommended to aid rapid ipecac-induced emesis, however, large volume intake may also have deleterious effects. We prospectively studied 121 children treated at home by a regional poison center to determine if a relationship existed between fluid volume and time to emesis. These children were treated in the usual manner except that parents were asked to measure the volume of fluid given and to note the time that fluid was given and the time of first emesis. The time ranged from 6 to 58 minutes (mean 20.6) with two who failed to respond and the volume ranged from 0 to 28 ounces (mean 6.7 ounces). In children who respond to ipecac, there is no significant relationship between the amount of fluid given and the time until emesis. We conclude that the traditional recommendation of forcing fluid with syrup of ipecac does not hasten emesis in children.

Beverages↗
PubMedDate not supplied

Diltiazem overdose: case report and review.

We present a case of diltiazem overdose in which the patient ingested 4.2 grams in an apparent suicide attempt. He arrived in the emergency department two hours postingestion with a blood pressure of 60/40 torr and a heart rate of 62 beats/min in a junctional rhythm. Intervention included activated charcoal, gastric lavage, intravenous fluids, calcium (both chloride and gluconate), dopamine, and atropine with improvement in vital signs. Diltiazem levels were obtained and half-life calculated. This ingestion is one of the largest reported in the literature and is remarkable in that the patient recovered without pacing or other extraordinary measures. All eight previously published cases of diltiazem overdose, including all unpublished reports to the manufacturer, are reviewed and their management strategies examined. Successful treatment in which recovery has occurred in less than 48 hours, includes pressors, calcium, glucagon, pacing, and charcoal hemoperfusion. A strategy for emergency physicians to use when approaching this problem is suggested from the review.

Adult↗