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S Refstad

Publications and source records attributed to S Refstad.

6 recordsLinked to original sources
PubMed2003

Paramethoxyamphetamine (PMA) poisoning; a 'party drug' with lethal effects.

Among young people in Norway the recreational use of amphetamine derivatives seems to be increasing. Methylenedioxymethamphetamine (MDMA), known as ecstasy, is the dominant substance, having both stimulant and psychedelic properties. Depending on the illegal source of these so-called 'party drugs' the content and purity can vary. This case report describes the first lethal case of paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA) intoxication reported in Norway. A 16-year-old male was admitted to a local hospital in a coma with seizures and hyperthermia after he had been found undressed and barefooted in a local forest (temperature 2 degrees C). He was intubated and given supportive care. Blood chemistry revealed hypoglycaemia, hypocalcaemia and hyperkalaemia. Shortly after transfer to the central hospital he developed bradycardia with continuous seizures and asystole. Adverse effects of MDMA are well described and include serotonergic and sympathomimetic symptoms with hyperthermia, coagulopathy, rhabdomyolysis and acute kidney and liver failure. Case reports of PMA deaths collectively suggest PMA to be more toxic than MDMA. A delayed effect after intake of PMA compared with MDMA can lead to increased intake. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. Increased thermo genesis will result in a search for cooling, which explains the attempt to undress and a desire to submerge in water. In a cool climate this behaviour itself can be lethal. Measures to treat seizures, hypoglycaemia, electrolyte anomalies and hyperthermia are the therapeutic goals. No specific treatment is available.

Adolescent↗
PubMed1978

Adult respiratory distress syndrome precipitated by massive salicylate poisoning.

Pulmonary oedema has been reported in severe cases of acetyl salicylic acid (ASA) poisoning. Liberal use of intravenous fluids, to establish a forced diuresis, is usually thought to be the precipitating cause. A case of severe ASA poisoning and respiratory failure was found to have increased pulmonary vascular resistance and signs of intravascular hypercoagulability. The patient recovered rapidly on mechanical ventilation with a positive endexpiratory pressure of 18 cm H2O and systemic steroids.

Aspirin↗
PubMed1976

Postanaesthetic use of naloxone hydrochloride after moderate doses of fentanyl.

A consecutive series of 273 anaesthetics is presented. All patients were given moderate doses of droperidol and fentanyl intravenously to supplement nitrous oxide and oxygen anaesthesia. 28.6% of the patients needed reversal of the analgesic respiratory depressant effect at the end of anaesthesia to establish stable spontaneous respiration. The opiate antagonist, naloxone hydrochloride (Narcan), was found to give rapid and reliable reversal of the respiratory depression. A mean dose of 2 mug/kg body weight of naloxone was found adequate in that no patient required further doses in the post-operative period in order to maintain adequate ventilation. Neither does the dose seem to have been too large. Patients in the naloxone group had no need for additional analgesics during the first 5 3/4 hours postoperatively, as compared to the painfree interval of 3 1/4 hours in the control group.

Adolescent↗