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Biomedical subjects

L Goldfrank

Publications and source records attributed to L Goldfrank.

At least 19 recordsLinked to original sources
PubMed1991

Morphine-ethanol interaction on body temperature.

1. The interaction between ethanol and morphine on core temperature was investigated in Swiss Webster mice. 2. Morphine (2.5-30 mg/kg) and ethanol (0.5-3.0 mg/g) administered individually resulted in a dose dependent decrease in body temperature. 3. When both drugs were injected simultaneously, body temperature decreased less than it would be expected to if the effects were additive. 4. Naloxone antagonized the hypothermic effect of morphine, but the hypothermic effect of ethanol and that of the combination of morphine plus ethanol was only reversed with high doses of naloxone (10 mg/kg). 5. Individual morphine and ethanol plasma levels were not significantly altered by their concomitant administration. 6. Binding of tritiated naloxone to opiate receptors in mouse brain membrane preparations was unchanged by pretreatment with ethanol (0.5 and 2 mg/g). 7. The interaction between morphine and ethanol was found to be less than additive and not related to pharmacokinetic changes of either drug.

Animals↗
PubMed1990

The medical complications of drug abuse.

There is a vast array of abused drugs, and only a few of the more commonly used substances have been discussed. Patients with drug abuse frequently present with atypical syndromes and diseases. These individuals usually have less social, medical and economic support, making them more susceptible to the diseases that are associated with poverty, such as tuberculosis, and the complications of diseases such as hypertension, congestive heart disease and diabetes that require long-term care. Our strategy in the evaluation of these patients should consider all these aspects of medicine. A meticulous assessment and comprehensive care are necessary to render quality care for these complicated human and toxicological problems.

Administration, Inhalation↗
PubMed1987

Hematologic aspects of toxicology.

Exposure to a number of toxins may result in a variety of hematologic abnormalities. Derangements of the synthesis of cellular elements, a shortened red cell half life, abnormalities of coagulation, and interference in oxygen-carrying capacity are some of the pathologic effects. Pharmacologic agents, heavy metals, and animal and insect venoms are among the toxins implicated in the production of hematologic abnormalities. This article focuses on some of these issues.

Blood↗
PubMed1986

The bodystuffer syndrome: a clandestine form of drug overdose.

The case histories of five people who ingested drugs in an attempt to conceal illegal substances when they were confronted by police are reported. They presented to an emergency department in various clinical states ranging from asymptomatic to comatose. This syndrome has been called "bodystuffing" by the authors, who differentiate it from "bodypacking," which is the ingestion of drugs for the purpose of smuggling. Bodystuffers may ingest one or more drugs, usually deny the ingestion, and are often not discovered until symptoms develop. Bodystuffers tend to be known drug dealers and are often drug abusers themselves. The ingestion is often unsuspected by authorities, but the act may also be witnessed but regarded as trivial. A common scenario is that of a person who is in an asymptomatic state when arrested and is later found comatose in jail. A variant of the syndrome is the ingestion of drugs to produce a medical condition that could defer incarceration.

Adult↗
PubMed1986

Esophageal tear following forceful removal of an impacted oral-gastric lavage tube.

We report an unusual complication of oral-gastric lavage in a drug overdose patient. During the lavage procedure, the oral-gastric tube became impacted in the esophagus. Forceful removal of the tube resulted in an esophageal tear. The patient did well with conservative management and was discharged with no long-term sequelae.

Administration, Oral↗
PubMed1986

A dosing nomogram for continuous infusion intravenous naloxone.

Naloxone hydrochloride is extremely valuable for diagnosing and managing the opioid overdose. Due to naloxone's short half life and a long duration of action of most opioids, repeated naloxone dosing often is required to prevent the recurrence of respiratory depression. An alternative to repeated bolus administration is a continuous IV infusion. We conducted a two-phase study to determine the pharmacokinetics of naloxone and to develop a continuous dosing nomogram. In the first phase seven patients were given an IV bolus dose alone and serial plasma naloxone levels were determined. Naloxone elimination was found to be biexponential with the mean beta half life equal to 0.023 +/- 0.002 reciprocal minutes in two patients and 0.015 +/- 0.02 reciprocal minutes in five patients. In the second phase ten volunteers were given either a 2-mg or a 4-mg bolus dose followed by a 1.5-mg/hr or a 3-mg/hr continuous infusion. The mean volume of distribution of the central compartment was found to be 0.806 +/- 0.408 L/kg. The mean beta rate constant of elimination was found to be 0.036 +/- 0.027 reciprocal minutes. A computer simulation of the pharmacokinetic parameters determined in our study found that a continuous infusion of two-thirds of the bolus dose that resulted in reversal each hour will maintain the plasma naloxone levels equal to or greater than the naloxone levels that would have existed 30 minutes following the bolus dose.

Adult↗
PubMed1985

Gastrotomy--a surgical approach to iron overdose.

Emesis and lavage often are ineffective in providing complete emptying of the stomach after an ingestion. With a locally corrosive and systemically toxic agent such as iron, surgical intervention with emergency gastrotomy may be required. We recently treated a 19-year-old man in the ED and in the departments of surgery and medicine who required a gastrotomy to remove a large amount of elemental iron inaccessible to removal by emesis, lavage, or gastroscopy. At gastrotomy the stomach showed full-thickness inflammation; the entire mucosal surface was hemorrhagic in nature. Gastrotomy was successful in allowing the removal of a large amount of the retained corrosive material. The severity of the findings at gastrotomy and the dramatic clinical improvement and recovery in our patient strongly support this approach if traditional methods fail.

Adult↗
PubMed1984

Management of overdose with psychoactive medications.

General management of the patient who has ingested an overdose of psychoactive medication is emphasized, since the suicidal patient has almost invariably taken multiple substances and often alcohol as well. The drug groups considered in detail include the sedative hypnotics, tricyclic antidepressants, phenothiazines, and lithium.

Antidepressive Agents, Tricyclic↗
PubMed1980

The emergency services physician assistant: results of two years' experience.

The physician assistant (PA) has become an integral part of urban health care. The roles chosen are diverse and often meet the particular needs of physicians or hospitals. We have developed a unique program in emergency services that allows for training and development of PAs in two distinctly different hospital settings. These PAs perform medical-surgical liaison work bridging what, at times, can be a complex cultural gap. It is our premise that these individuals can significantly improve the quality and quantity of care rendered.

Ambulatory Care↗