Resuscitation after nifedipine overdose exclusively with intravenous calcium chloride.
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Biomedical subjects
Publications and source records attributed to L M Haddad.
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Tricyclic antidepressant overdose is the most common cause of death from prescription drugs. Clinical presentation of overdose from the tricyclic agents includes cardiac arrhythmias, hypotension, seizures, coma and anticholinergic signs such as hyperthermia, flushing and intestinal ileus. The highly toxic/lethal level (greater than 1,000 ng per mL) is manifested on electrocardiograms as prolongation of the QRS interval to 100 milliseconds or more. Treatment includes establishment of an airway, proper oxygenation and ventilation, fluid replacement at maintenance levels, cardiac monitoring, gastric lavage and charcoal administration, alkalinization to a blood pH of 7.5 with intravenous sodium bicarbonate, supportive therapy and continued cardiac monitoring after clinical recovery.
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A case report of survival after severe ingestion of phenol is described. The patient developed coma, respiratory arrest 30 minutes postingestion, hypotension, ventricular arrhythmias, metabolic acidosis, seizures, selective elevation of uric acid and gastrointestinal disturbances. Treatment consisted of gastric lavage, olive oil, activated charcoal and supportive therapy. The exact amount of ingested substance was known, and ventricular arrhythmias specifically related to phenol, not its derivatives, could be described.
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Based on the metabolism, pathophysiology and clinical picture of iron poisoning, a treatment protocol for the emergency department is presented. For insignificant amounts, treatment is ipecac and oral bicarbonate. For ingestions of amounts greater than 150 mg/kg, even if the patient is asymptomatic, hospital observation is necessary. Chelation therapy with Desferal is reserved for patients with free serum iron, and probably for patients who present in coma, shock, or convulsions.
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Most street hallucinogens contain either LSD or phenycyclidine HCl (PCP). Because the acute phase of LSD and PCP mimic several other drugs and conditions, it is important to exclude these other possibilities. When faced with LSD or PCP, "talking down" usually suffices for the mild case; management becomes more complex should hyperpyrexia, coma, seizures or a hypertensive crisis ensue. Diazepam, not a phenothiazine, is preferred for sedation.