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Yoram Finkelstein

Publications and source records attributed to Yoram Finkelstein.

7 recordsLinked to original sources
PubMed2006

Pediatric cinnarizine overdose and toxicokinetics.

Cinnarizine, a piperazine derivative, is a widely prescribed medication for the treatment of vestibular disorders and motion sickness. Cinnarizine has antihistaminic, antiserotoninergic, antidopaminergic, and calcium channel-blocking properties. We present the first report in the English literature of cinnarizine poisoning and toxicokinetics. A 30-month-old toddler ingested 225 mg of cinnarizine, 18 times the recommended dose for older children. Four hours later, she became jittery with a wide-based gait and vomited 3 times. She was examined by her family physician, who reported stupor and twitching in both hands. On admission to the hospital, 6 hours after the ingestion, she was stuporous and had 3 short, generalized tonic-clonic convulsions that were controlled with a single dose of midazolam. Full clinical recovery was seen 10 hours after ingestion. Serum cinnarizine levels were 7407, 2629, and 711 ng/mL on admission and at 4 and 12 hours thereafter, respectively, 26.9 times higher than the therapeutic levels in adults. Elimination rate constant, calculated by linear regression of the ln concentrations of the 3 data points, was 0.19. Half-life, calculated from the equation t(1/2) = 0.693/kel, where kel is the elimination rate constant, was 3.65 hours. The manufacturing company revealed that their database contains 23 reports of cinnarizine overdose (adult and children), received between 1972 and 2004. Clinically, these cases reflect mainly symptoms of alterations in consciousness ranging from somnolence to stupor and coma, vomiting, extrapyramidal symptoms, and hypotonia. In a small number of young children, convulsions developed; recovery was uneventful in 4 cases and not reported in 1. The neurologic complication may be explained by the antihistaminic effect of cinnarizine because central nervous system depression and convulsions are known complications of antihistaminic overdose. It is hypothesized that cinnarizine-induced convulsions also are related to the antidopaminergic effect of the drug. Apart from the convulsions, no other adverse effects related to calcium channel-blocking properties, such as bradycardia or hemodynamic instability, were observed. Pediatric patients with cinnarizine overdose need to be observed in a health care facility for potential neurologic complications and be treated symptomatically. The delay to onset of clinical effect should be considered in the observation period.

Accidents, Home↗
PubMed2006

Respiratory failure in a neonate after folk treatment with broom bush (Retama raetam) extract.

OBJECTIVES: To increase the awareness of intoxication by folk herbal remedies in the pediatric population. METHODS: Case report of a 7-day-old baby boy admitted to a pediatric intensive care unit in a university-affiliated hospital. RESULTS: The patient presented with respiratory failure and central nervous system depression. Specific questioning of the parents revealed consumption of folk herbal remedy by the neonate. Mechanical ventilation was used for 24 hours until normal activity level resumed. CONCLUSIONS: The possibility of intoxication in a neonate should not be overlooked. Folk herbal remedies, especially if taken in larger than recommended amounts, may be hazardous. Accessible herbal and folk medicine data bank will contribute to a better treatment of patients having side effects of these remedies.

Genista↗
PubMed2004

Emergency treatment of life-threatening intrathecal methotrexate overdose.

A male 34-year-old patient with aggressive diffuse malignant lymphoma was hospitalized for treatment. Because of high likelihood of CNS involvement, intrathecal methotrexate (MTX) 15 mg was administered with hydrocortisone 100mg. Shortly after the intrathecal injection the patient became agitated, and complained of severe low back pain and 2h later he became confused and developed generalized seizures. At this stage, it was realized that the dose contained 1200 mg of MTX (80-fold overdose). The patient developed ARDS and was comatose; he was intubated and transferred to ICU. The patient was immediately treated with intravenous leucovorin 1200 mg, and 15 mg every 6h, thereafter, for 72 h. In addition, CSF exchange with warm normal saline was initiated via intrathecal catheter, and a total of 200 ml of CSF were replaced during 48 h. Finally, at the end of the exchange 2 mg of leucovorin with 2 mg of dexamethasone were administered intrathecally. MTX levels in CSF 7h post-injection were 770 microM, and increased to 1250 microM 2h later. Thereafter, the levels in CSF declined, and 48 h post-injection were 47 microM. The plasma levels of MTX 7h post-injection were 10 microM, and declined to 0.7 microM at 68 h. The patient regained consciousness and underwent successful weaning from ventilator after tracheostomy. The highest reported intrathecal dose after which the patient survived was 625 mg. Due to the rarity of reported cases, there are no clear guidelines for treatment of massive intrathecal overdose. There is a controversy regarding the toxicity of intrathecal injection of leucovorin. We propose CSF exchange and intravenous leucovorin as the mainstay of treatment.

Adult↗
PubMed2003

[Ammonia and ammonium salts: remedy and poison, myth and time honored reality].

The public interest in ammonia and its salts has risen due to the recent water crisis in Israel. The focus on their regulatory and environmental aspects has been intensified due to the elevated levels of ammonium salts in the national water system, resulting in a banning of water use in the Dan district. To the public it is commonly known that ammonia is toxic. Nevertheless, the medical view regarding ammonium salts is very different from that of ammonia gas. In contrast to the hazardous ammonia gas, its salts (such as ammonium bicarbonate) are considered to be much less toxic and are widely used as medicaments and food additives. Thus, although the presence of ammonium salts in the drinking water may indicate contamination, this is not a case of poisoning associated with toxic side effects.

Ammonia↗
PubMed2002

Progressive parkinsonism in a young experimental physicist following long-term exposure to methanol.

A case is described of an experimental physicist who developed parkinsonism, apparently as delayed toxic effect of long exposure to vapors of methanol in the laboratory. Clinical and magnetic resonance imaging (MRI) supported the diagnosis, after exclusion of hereditary diseases and primary degenerative diseases. Screening for heavy metals in urine and plasma ceruloplasmin was negative. This case illustrates the neurotoxic delayed effect of long-term exposure to methanol with no episodes of acute intoxication. The setting of a research laboratory with prolonged exposure to mixed single crystals and inhalation of methanol vapors may exist in other academic and hi-tech environments, and pose the risk of similar delayed toxic influences.

Adult↗