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Biomedical subjects

K Blaho

Publications and source records attributed to K Blaho.

At least 19 recordsLinked to original sources
PubMed2000

Blood cocaine and metabolite concentrations, clinical findings, and outcome of patients presenting to an ED.

The purpose was to determine if blood cocaine or metabolite concentrations would accurately reflect the severity of clinical findings in patients presenting to the emergency department, identifying those requiring therapeutic intervention or those at risk for poor outcome. Blood for determination of cocaine and metabolite concentrations was drawn from patients and were determined by an extractive alkylation/mass spectrometry procedure. The mean blood concentrations (mg/L) in 111 patients were as follows: cocaine, 0.26 +/- 0.5; ecgonine 0.42 +/- 0.47; ecgonine methyl ester 0.21 +/- 0.37, norcocaine 0.03 +/- 0.17; benzoylecgonine 1.28 +/- 1.29, cocaethylene 0.02 +/- 0.06. Two patients died, 23 required hospital admission, and 88 were discharged from the ED. There was no statistical correlation between cocaine or any metabolite concentration and the severity of clinical symptoms, disposition, need for treatment or outcome. Blood cocaine and metabolite concentrations should be interpreted with caution because they vary widely and do not predict the severity of clinical findings, the incidence of adverse effects, outcome, or need for interventional therapy.

Adolescent↗
PubMed2000

Cocaine metabolism in hyperthermic patients with excited delirium.

The half-life of cocaine in clinical experiments has been reported to range from 60 to 90 min. It has been previously suggested that elevated temperature may accelerate the metabolism of cocaine. However, there is no clinical data to indicate the presence of hyperthermia like that seen in excited delirium alters the half-life of cocaine. We report the results of half-life determinations from serial cocaine concentrations in two patients with excited delirium. Both patients presented to the emergency department with classic findings of excited delirium that included hyperthermia, agitation, and cardiovascular aberrations. One patient died despite aggressive therapeutic intervention. Cocaine and metabolite concentrations were determined by an extractive alkylation mass spectrometry procedure. Presenting cocaine concentrations in patient 1 and patient 2 were 0.387 and 0.266 mg/L respectively. Results from pharmacokinetic modeling of the serial concentrations show that the half-life of cocaine was not significantly accelerated, despite the presence of hyperthermia. Data from these two cases provide further evidence that catastrophic reactions to cocaine are independent of amount or route of administration, and that the metabolism of cocaine, at least in these patients, was not altered by hyperthermia.

Journal Article↗
PubMed1998

Multiple cocaine-induced seizures and corresponding cocaine and metabolite concentrations.

The etiology of seizures associated with cocaine use is unclear. Because cocaine seizures are relatively uncommon, they should be diagnosed by exclusion and a neurological workup to rule out central nervous system (CNS) catastrophe should be made. This report describes the clinical findings, treatment, and blood cocaine and metabolite concentrations in a patient who, on two separate occasions, had seizures associated with crack cocaine ingestion. Approximately 1 hour after the ingestion incidents, the patient had multiple, generalized seizures that abated spontaneously. His workup for CNS bleeding, infection, and trauma was negative. Cocaine concentrations on the first incident peaked at 2.48 mg/L and on the second incident peaked at 3.9 mg/L. Other clinical findings included tachycardia, hypertension, diaphoresis, and disorientation. Blood cocaine and metabolite analysis revealed extremely high concentrations. Other than the incident of seizures and transient cardiovascular aberrations, these high concentrations were tolerated by the patient without further sequelae. A review of cocaine-induced seizures and treatment is included.

Adult↗
PubMed1996

Envenomation from the brown recluse spider: review of mechanism and treatment options.

The brown recluse spider in commonly found throughout the midsouth region of the United States. Bites from the brown recluse occur when the spider is trapped in clothing or its nest is otherwise disturbed. The bite may be undetected by the patient until hours or days later when a characteristic lesion develops. Mild reactions to envenomation are usually limited to a lesion only. In some cases, a severe reaction results which can be life-threatening. Although there have been case reports of various pharmacological agents used for the treatment of brown recluse bites, none have been shown to be consistently effective. Therapy for brown recluse bites remains centered around aggressive wound care. Early surgical excision has not been shown to be of benefit and in most cases delays healing. This review focuses on the physiological mechanisms of the brown recluse venom and current treatment options.

Journal Article↗
PubMed1996

Pediatric growth and development.

Most children with congenital anomalies, teratogenesis, inborn errors of metabolism, and acquired toxicity or injury will have abnormal growth and development during the first few years of life. Many of the conditions are treatable, and early intervention is associated with improved prognosis. Developmental and growth assessment should be part of any routine visit to a primary care clinician. An overview of normal growth and development is outlined, and some common abnormalities are discussed.

Child↗
PubMed1996

Pharmacological considerations for the pediatric patient.

The use of pharmacological agents in children warrants special consideration because children have variable pharmacokinetic parameters. Not only are the pharmacokinetic properties of drugs different in children as compared with adults, but these properties can undergo rapid change as children grow and mature. Furthermore, many drugs that would be useful in the pediatric population lack the indication for use in children and, therefore, dosing guidelines are not available. This paper presents an overview of basic pharmacokinetics in children and pediatric dosing guidelines.

Absorption↗
PubMed1995

Determining the true cause of death in a dermatological disaster.

Adverse drug reactions that result in patient death warrant special consideration to determine if the outcome was preventable. We report the results of an investigation into the cause of death of a 63 year old male who was thought to have phenytoin-induced toxic epidermal necrolysis (TEN). Most dermatological reactions from drugs are minor and resolve without sequelae once the drug is discontinued. In some cases, reactions are severe and can be life threatening. The patient arrived at the emergency department with extensive exfolative dermatitis. The differential diagnosis included phenytoin-induced TEN, scalded skin syndrome, and phenytoin hypersensitivity. After he was admitted his clinical status deteriorated and he died 13 days after admission. Autopsy findings were significant for necrotizing dermatitis, necrotizing pneumonia, multiple herpetic ulcerations, multisystem organ failure and blood cultures grew Staphylococcus aureus (TSS toxin positive). Findings that indicate a cause of death other than a drug-induced dermatological reaction are presented as well as an overview of the patients' medical history. The differential diagnosis of drug induced skin lesions are also discussed.

Journal Article↗
PubMed1995

The role of pharmacology and forensics in the death of an asthmatic.

Comprehensive investigation is necessary for determining the cause of death in cases with positive drug screens. We investigated the case of a male who reportedly expired from an acute asthma attack. He had limited access to both therapeutic drugs and drugs of abuse because he was a state prisoner. His autopsy was remarkable because the weights of his right and left lungs were 690 and 760 g, respectively. His upper airway was clear of debris. There was an abundant amount of blood and frothy fluid in the pulmonary parenchyma. There were no focal lesions. The pulmonary vasculature was unremarkable. Microscopic evaluation of the lung tissue showed that the bronchi contained dense inflammatory infiltrates consisting mostly of eosinophils and a few lymphocytes and plasma cells. Basement membrane thickening was evident in the bronchi, and mucous plugs were identified in some of the bronchial lumina. A morphine concentration of 80 ng/mL was found in the blood. Theophylline and albuterol were detected in trace amounts. The opinion of the coroner was that the patient died of an acute asthma attack, and the presence of morphine may have contributed to his death. A careful review of his medical history and the mechanisms of drug-induced asthma revealed that the etiology of his death was more likely due to heroin abuse and noncardiogenic pulmonary edema. Episodic exacerbations of his chronic asthma were a contributing factor in his demise. However, in and of itself, asthma was not responsible for his death. Pertinent information associated with this case is presented, along with additional findings of toxicological screens and other evidence demonstrating that his asthma treatment did not contribute to his death. In addition, opiate-induced asthma, as well as other drug-induced diseases that can contribute to mortality in patients who abuse narcotics, is reviewed.

Administration, Inhalation↗
PubMed1993

AOA's current trends in pharmacology and therapeutics histamine and antihistamine agents.

BACKGROUND: Drugs that selectively block the H-1 subtype of histamine receptors are known as classical antihistamines. METHODS: These agents are used for the symptomatic relief of allergies and colds and because they act in a manner similar to atropine, and are often used for their anticholinergic effects. They are readily available as prescription and over-the-counter medications and it is likely that the practicing optometrist will encounter these drugs in their patient population. RESULTS: Antihistamines produces several common ocular side effects that include blurred vision, diplopia, mydriasis, and decreased lacrimation. CONCLUSIONS: This article reviews the physiology of histamine as it relates to the pharmacology of antihistamines, the mechanism of action, and adverse effects associated with the classical antihistamines.

Contraindications↗
PubMed1992

Non-steroidal anti-inflammatory drugs: current trends in pharmacology and therapeutics.

Non-steroidal anti-inflammatory drugs (NSAIDS) are commonly used for the chronic treatment of many inflammatory disorders. They are also used for the reduction of fever and mild to moderate pain. Because they are readily available to patients as both prescription and over-the-counter medications, it is likely that the practicing optometrist will encounter these agents in the practice setting. NSAIDS are associated with several common ocular and systemic adverse effects that include nonspecific conjunctivitis, blurred vision, allergic reactions and bleeding disorders. This article reviews the mechanism of action of NSAIDS as well as common or severe ocular and systemic side effects.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1986

Effect of allopurinol and dimethylsulfoxide on long-term survival in rats after cardiorespiratory arrest and resuscitation.

The effects of allopurinol and dimethylsulfoxide (DMSO) upon reperfusion injury were tested in separate studies that utilized a rat model of cardiorespiratory arrest and resuscitation. The rats were subjected to 7 minutes of arrest followed by resuscitation, and then were alternately assigned to either a drug-treated group or a vehicle-treated group (n = 22 for all groups). Drug treatment was given after the return of spontaneous circulation, and survival was monitored for a ten-day period. Study 1 utilized DMSO (50% solution, 1 ml/kg) as the test drug and saline solution as the vehicle. The percentages of surviving rats in the DMSO-treated and vehicle-treated groups were never statistically significantly different. There were 59% (13/22) of the DMSO-treated rats and 63% (14/22) of the vehicle-treated rats alive at one hour after resuscitation. Survival rates decreased to 18% (4/22) of DMSO-treated rats and 22% (5/22) of vehicle-treated rats on days 3 through 10. Allopurinol (25 mg/kg) was the test drug in study 2, and 0.18-M sodium hydroxide was the vehicle. The survival rate of resuscitated rats was statistically significantly greater at two days in the drug-treated group (68%, 15/22) than in the vehicle-treated group (36%, 8/22) (chi 2 = 4.46, df = 1, P less than 0.05). The difference increased to a maximum of 68% (15/22) of the allopurinol-treated group versus 27% (6/22) of the vehicle-treated group at days 7 and 8 (chi 2 = 7.38, df = 1, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Allopurinol↗
PubMedDate not supplied

Diagnosis and management of the drug overdose patient.

The manifestations of drug overdose can be complex and result in a variety of physiological effects. Drug overdose situations involving multiple agents further confuse the clinical picture. The clinician must be able to diagnose and treat the patient to prevent unnecessary morbidity or mortality. Often the risk of treating drug overdose with an additional pharmacological agent outweighs the potential benefit. In these cases, the best treatment may involve observation alone. This review describes the current diagnostic and management techniques for the drug overdose patient. Specific drug groups that are commonly used for overdose are discussed with emphasis on physiological manifestations of intoxication and poisoning and the potential for delayed effects. Treatment options for various groups are also discussed. It appears that invasive procedures such as gastric lavage and whole-bowel irrigation are not appropriate for the majority of overdose situations. The use of oral activated charcoal may also be of limited value. As specific antidotes for drug overdose are not widely available, supportive treatment must be based on the individual patient.

Drug Overdose↗
PubMedDate not supplied

Clinical pharmacology of lysergic acid diethylamide: case reports and review of the treatment of intoxication.

Intoxication and overdose are common presenting complaints to the emergency department. Acute intoxication with lysergic acid diethylamide (LSD) has become a relatively rare event, especially when compared with the incidence of ethanol and cocaine intoxication. We recently had an outbreak of presumed LSD intoxications occurring over one weekend. All patients had attended a performance by the musical group The Grateful Dead. At present, LSD intoxication or overdose can only be suspected based on clinical findings because there are no readily available rapid laboratory tests for detecting either the parent compound or the metabolites of the drug. The clinical findings and outcomes of five patients with suspected LSD intoxication are presented. The pharmacological effects of LSD and treatment modalities of intoxication are reviewed. All patients were treated conservatively based on clinical signs and symptoms. Only one patient required hospital admission for combative behavior that was initially refractory to pharmacological restraint.

Adult↗