Biomedical subjects

Larissa I Velez

Publications and source records attributed to Larissa I Velez.

9 recordsLinked to original sources

PubMed2006

Systemic toxicity after an ocular exposure to xylazine hydrochloride.

There are limited reports of human overdose with the animal tranquilizer, xylazine hydrochloride. The reported effects include hypotension, bradycardia, and respiratory depression. Ocular exposures to xylazine have not been previously reported. A 38-year-old man arrived in the Emergency Department, reporting the accidental irrigation of both eyes with approximately 8 mL of xylazine (100 mg/mL) 30 min before arrival. The patient was asymptomatic. The eyes were copiously irrigated with isotonic crystalloid. Two hours after the exposure, the patient developed sinus bradycardia (40-50 beats/min), hypotension (90/60 mm Hg), and a decreased level of consciousness. The patient was admitted for observation, during which the bradycardia and hypotension were noted to persist. He remained otherwise asymptomatic. The symptoms resolved without intervention, other than i.v. fluids, approximately 25 h after the exposure. The patient was discharged home. This case demonstrates that ocular exposure to xylazine can cause systemic central nervous system and cardiovascular effects.

Accidents, Occupational↗

PubMed2004

Delayed salicylate toxicity at 35 hours without early manifestations following a single salicylate ingestion.

OBJECTIVE: To report a case of delayed toxicity following a single ingestion of aspirin, where the initial concentrations were nearly undetectable and the patient was completely asymptomatic for the first 35 hours. CASE SUMMARY: A 14-year-old white female was evaluated after a single ingestion of 120 tablets of aspirin 81 mg/tablet hours before arrival to the emergency department. She denied nausea, abdominal pain, tinnitus, or shortness of breath. She received one dose of activated charcoal. The first salicylate concentration (4 h after ingestion) was 1 mg/dL. At 35 hours, the patient became symptomatic (dizziness, tinnitus, epigastric discomfort). Her salicylate concentration at that time was 46 mg/dL. A second dose of activated charcoal was administered, and intravenous bicarbonate with potassium was started as a continuous infusion for 30 hours. DISCUSSION: While delayed salicylate toxicity is well reported in the literature, no report was found regarding concentrations increasing to toxicity 35 hours after ingestion. The delayed aspirin absorption may be due to salicylate-induced pylorospasm or the formation of pharmacobezoars. CONCLUSIONS: In cases with known salicylate ingestion, it is important to follow salicylate concentrations every 4 hours until they are steadily decreasing according to a 4-hour half-life and the patient shows no symptoms of salicylate intoxication.

Adolescent↗

PubMed2004

Unintentional intravenous infusion of Golytely in a 4-year-old girl.

OBJECTIVE: To report an accidental intravenous infusion of Golytely (polyethylene glycol and electrolyte solution; PEG-ELS) in a pediatric patient that did not result in systemic toxicity. CASE SUMMARY: A 4-year-old Hispanic girl presented to the emergency department after ingestion of approximately 24 tablets of 6-mercaptopurine (6-MP) 2 hours earlier. She vomited twice after receiving syrup of ipecac at home. Upon arrival, her vital signs were temperature 36.2 degrees C, heart rate 102 beats/min, respiratory rate 42 breaths/min, and blood pressure 115/67 mm Hg. Her physical examination was normal. The patient received activated charcoal 1 g/kg. Golytely administered through a nasogastric tube was ordered. Upon reevaluation, it was noted that the patient had received 391 mL of Golytely intravenously. The infusion was immediately stopped. There was no evidence of acidosis, renal failure, or ethylene glycol toxicity. She was admitted for observation and was discharged 36 hours later. DISCUSSION: As of April 29, 2004, accidental intravenous infusion of PEG-ELS has not been previously reported. Potential toxicity from Golytely is mainly related to the molecular weight of PEG in the formulation. PEG can theoretically be degraded to ethylene glycol. It is thus important to monitor acid-base status, renal function, and pulmonary function in these patients. CONCLUSIONS: When administered correctly, an infusion of PEG-ELS by nasogastric tube is a safe gastrointestinal decontamination technique used in toxicology; PEG-ELS is not indicated for intravenous administration. Protocols need to be implemented in the workplace to minimize errors in the delivery of treatment to patients. Fortunately, this patient did not have any toxicity from the intravenous infusion of Golytely.

Child, Preschool↗

PubMed2004

Intentional bupropion overdoses.

Bupropion is an antidepressant that has recently seen increased usage in smoking cessation. This increased usage, along with its potential for causing seizures, has renewed interest among clinicians about the effects of this drug. The purpose of this study is to describe the clinical course of intentional bupropion overdoses in adults and adolescents. This study is a retrospective review of intentional bupropion overdoses reported to regional poison centers over a 2-year period. Our review included 385 cases. Women accounted for 63% of cases and ages ranged from 12 to 57 years. Significant clinical effects were noted in 26% of cases. Seizures were reported in 11% of patients. Seizures occurred within 6 h in most patients. Other prominent effects included tachycardia, agitation, and hallucinations. In conclusion, after a bupropion overdose, patients frequently display agitation, tachycardia, hallucinations and seizures. Seizures commonly occur within 6 h of the ingestion. However, seizures may occur beyond this time frame, particularly if persistent tachycardia, agitation, or hallucinations are noted.

Adolescent↗

PubMed2004

Iron bezoar retained in colon despite 3 days of whole bowel irrigation.

Concretion formation is a documented complication of large iron ingestions. The generally accepted treatment is supportive care, whole bowel irrigation, and intravenous deferoxamine for systemic toxicity. Laparotomy and gastrotomy have also been used in patients with a high iron burden and bezoar formation. Though experiments suggest that iron is poorly absorbed in the colon, there are no case reports of iron overdose without systemic toxicity, despite a retained colonic bezoar. We report the case of a 16-month-old who presented to an Emergency Department 19 h after an iron ingestion. Initial laboratory studies revealed an anion gap of 14 mEq/L, and a 20 h serum iron concentration of 429 mcg/dL. An abdominal radiograph revealed multiple pills throughout the stomach and small bowel; whole bowel irrigation was initiated. Deferoxamine was administered at 10 mg/kg/h and then stopped when the serum iron level reached 27 mcg/dL, 36 h later. At this time, the abdominal radiograph showed an iron bezoar remaining in the ascending colon despite a clear rectal effluent from whole bowel irrigation. Despite whole bowel irrigation over the next 36 h, the iron bezoar was not removed and actually migrated proximally in the colon. Treatment was stopped on the third day and a normal diet was instituted with prompt passage of the bezoar.

Antidotes↗

PubMed2004

Language preferences among callers to a regional Poison Center.

Providing service to non-English speaking populations is a common challenge facing Poison Centers (PC). Previous studies have identified that people who do not speak functional English are unlikely to call a PC. We developed a survey to determine the language preferences of poison center callers and to identify if we were failing to offer services in languages other than English to callers who felt they needed them. We surveyed 322 parents during routine callbacks about language spoken at home, first and second languages, country of birth, and satisfaction with language used by the PC. We found that 93% primarily spoke English, 5% spoke English and Spanish, and 5% spoke other languages at home in a region where approximately 10% of the population speak English poorly. The majority of respondents were born in the US and were comfortable using English when using the PC. There were 6 cases where callers would have preferred using a different language. Our study supports data suggesting that poison centers are underutilized by people that are recent immigrants and speak English poorly. Awareness programs and educational efforts should be directed toward this sub-population.

Communication Barriers↗

PubMed2003

Serotonin syndrome with elevated paroxetine concentrations.

OBJECTIVE: To describe a case of serotonin syndrome due to paroxetine and ethanol. CASE SUMMARY: A 57-year-old white man was brought to the emergency department one day after ingesting paroxetine 3600 mg and a pint of hard liquor. He denied the use of any other drug or herbal products and regular use of alcohol. Upon arrival to the hospital, vital signs were blood pressure 188/103 mm Hg, heart rate 114 beats/min, respiratory rate 28 breaths/min, temperature 36.8 degrees C, and O2 saturation 96% on room air. Findings on physical examination included dilated pupils, facial flushing, diaphoresis, shivering, myoclonic jerks, tremors, and hyperreflexia. A tentative diagnosis of serotonin syndrome was made. Initially, cyproheptadine 8 mg was administered orally with no observable effect. An additional 12 mg was given in 3 doses over 24 hours. Symptoms abated slowly over the next 6 days, during which a thorough evaluation failed to reveal any other potential causes for the patient's condition. Serum paroxetine concentrations at 27.5 and 40 hours after ingestion were 1800 and 1600 ng/mL, respectively (normal 20-200 ng/mL). DISCUSSION: Serotonin syndrome is rarely reported in patients taking only one serotonergic medication. Although serum paroxetine concentrations have not been shown to correlate with efficacy or toxicity, our patient's serum paroxetine concentration was 9 times the upper end of the therapeutic range. Cyproheptadine, which has been suggested as a therapy, did not appear beneficial in this patient. Use of the Naranjo probability scale indicated a probable relationship between the serotonin syndrome and the overdose of paroxetine taken by this patient. CONCLUSIONS: More studies are needed to better assess the role of cyproheptadine and other serotonin antagonists in the management of the serotonin syndrome. Regardless of the use of cyproheptadine or other agents, attention should be paid to fluid status, decontamination, and management of hyperthermia, agitation, and seizures.

Drug Overdose↗

PubMed2003

Inhalational methanol toxicity in pregnancy treated twice with fomepizole.

We describe a pregnant patient with a long history of inhalant abuse who came to our hospital twice during her pregnancy. In both admissions, she was treated with fomepizol (4-MP), a newly available alcohol dehydrogenase antagonist for treatment of ethylene glycol poisoning.

Administration, Inhalation↗

PubMed2003

Death by quinine.

We report a case of a man with a 9.75 g ingestion of quinine. The patient presented with recurrent pulseless wide complex tachycardia for which he received sodium bicarbonate, defibrillation and overdrive mechanical pacing. Despite treatment, the patient died. Quinine is still available for the treatment of leg cramps and drug-resistant malaria. In overdose, quinine affects multiple organ systems, including vision, hearing, the cardiovascular, and renal systems. We review the current approach to quinine intoxication.

Adult↗