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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Tramadol,Seizures,Ejaculation,Shoulder dislocation
- چکیده:
- چکیده انگلیسی: Background: One of the side effects of tramadol is seizure. Tramadol is a synthetic analgesic used to treat mild to moderate pain. Tramadol can cause seizures in the range of treatment and toxic doses. This seizure is usually in a generalized tonic-clonic from and usually occurs in the first 24 hours after ingestion.
Case Presentation: The patient was a 32-year-old man referring to the emergency department with a right shoulder joint dislocation. It was reported that after a tonic-clonic seizure for about 1 minute, it has been followed by foaming at the mouth, eye lifting, urinary incontinence and loss of consciousness for about 5 minutes. He used a combination substance of sildenafil and tramadol to treat an early ejaculation. The patient has referred to the hospital 5 times with shoulder dislocation, without providing a detailed explanation about the use of tramadol and subsequent seizures
Discussion: Tramadol misuse and overdose is a common medical issue in Iran and around the world. Regarding the arbitrary use of tramadol in Iran, especially through the non-scientific prescriptions by apothecaries in some cases such as early ejaculation treatment, attention to patient records along with the cause of referral is essential.
Conclusion: Considering the prevalence of tramadol use, the community of physicians is advised to think of tramadol as a common cause for shoulder dislocation.- انتشار مقاله: 13-11-1397
- نویسندگان: Alireza Ghassemi Toussi,Alireza Ghassemi Toussi,Alireza Ghassemi Toussi
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Substance-related disorders,Amphetamines,Delusional Parasitosis,Pruritus
- چکیده:
- چکیده انگلیسی: Amphetamine abusers are shown to have significant cognitive impairments as well as delusional disorders. We present a 17-year-old man who was admitted to the toxicology emergency department with amphetamine overdose. Along with the classic signs and symptoms of overdose including mydriasis, tachycardia, hypertension, sweating and severe agitation, his urine toxicology screen test was found to be positive for 3,4-methylenedioxy-methamphetamine. In physical examination, widespread round-to-oval cutaneous lesions were observed all over his limbs and chest, notably the most easily reached sites of skin to be scratched. After regaining consciousness, the patient complained of pruritus and sensing the movement of insects under his skin. Further medical history showed that he had abused amphetamines for more than two years along with persistent pruritus, for which he had visited different physicians who mainly had made the diagnosis of allergy or dermatitis for him. He had been treated with antihistamines (hydroxyzine) for a long period. He also had been diagnosed with scabies and treated with topical permethrin and lindane lotion. Despite receiving these treatments, he continued to have pruritus particularly on his forearms and hands. He was finally diagnosed with “Ekbom’s syndrome” and referred to psychological rehabilitation and psychosomatic outpatient clinic.
- انتشار مقاله: 14-06-1394
- نویسندگان: Maryam Vahabzadeh,Alireza Ghassemi Toussi
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Opioids,Body Packer,Illicit Drugs
- چکیده:
- چکیده انگلیسی: Case: A 26-year-old man referred to emergency service with coma, bradypnea (respiratory rate = 4 breaths per minute) and pinpoint pupil. On chest auscultation, diffuse coarse crackle and on abdominal auscultation, decrease of abdominal sounds were found. At first evaluation, pulse oximetry showed 19% saturation of oxygen. After oxygen therapy with facial mask and infusion of 8.4 mg naloxone in divided doses, he regained consciousness with normal respiratory rate (16 breaths per minute) with 98% saturation of oxygen. The patient denied use of any illicit substances; however, due to triad of bradypnea, miosis and decreased level of consciousness, and also responsiveness to naloxone, the physician suspected opioid overdose and decided to admit the patient in Mashhad Medical Toxicology Center in Imam Reza Hospital. Forty minutes later, the patient deteriorated with decrease of oxygen saturation, tachypnea and decrease of consciousness. Chest X-ray showed diffuse infiltration in both lungs. In the urine screen test morphine metabolites were detected. Abdominal plain X-ray showed several compacted solid materials in rectum and colon (Figure 1). What are the differential diagnoses and appropriate management of this patient? Differential diagnoses: The principle problems of this patient were relapse of unconsciousness in addition to miosis and apnea or bradypnea that suggest a) opioid toxicity, b) body packer, c) body stuffer, d) acute respiratory distress syndrome (ARDS), e) clonidine toxicity, f) parasympathomimetic agents toxicity, g) organophosphate toxicity, h) carbamate toxicity, i) sedative hypnotic toxicity, j) ethanol toxicity and k) barbiturate toxicity (Table 1). Approach: the presence of miosis, bradypnea and decrease of consciousness in addition to positive response to naloxone, is highly suggestive of opioid toxicity (1). Notwithstanding, recurrent decrease of consciousness can be attributed to release of high amount of opioid in blood circulation which mostly occurs in opioid body packers and body stuffers (2). Treatment: After admission to medical toxicology department, the patient became intubated with mechanical ventilation support with high positive end expiratory pressure (PEEP). Consequently, O2 saturation increased to 89%. Whole bowel irrigation with 70 g polyethylene glycol (PEG) was prescribed in 1000mL water per hour and after 4 doses, the patient defecated 23 intact packs with 1 semi open pack that contained raw opium (Figure 2). Subsequent to 2 other doses of PEG, the patient defecated only lucid water with no remaining pack. Due to the presence of tachypnea, coarse crackle on chest auscultation, and clinical suspicion of the opioid induced lung injury (ARDS), further doses of naloxone were not administered. In addition, ceftriaxone (2 g stat and 1 g q 12 h) and clindamycin (600 mg q 8 h) were administered intravenously. In the next abdominal X-ray no pack was seen. Etiology: Body packers are illicit drug smugglers that swallow many packs with careful packing for the aim of transferring illicit substances including opioids, amphetamines and cocaine between two specific locations (1-4). On condition that the packs are torn in the alimentary tract, the substance leaks and the person can be influenced by active ingredients of the substance (5). The active ingredients can be absorbed through entroentric cycle or entrohepatic cycle. Hence, recurrent opioid triads occur refractory to naloxone therapy. The other similar but more life-threatening situation is body stuffer. These people swallow packets of illicit substances that are not carefully wrapped on due to having limited time when they are on escape or on police arrest. This group is prone to severer toxicity (2,6). Outcome: This patient was on mechanical ventilation for 30 hours. His pulmonary function upturned to normal condition. Then he was weaned off and extubated. The patient was discharged on the third day post-admission with good condition. Conclusion: Body packers may give misleading history. Moreover, physician may neglect body packer as one of differential diagnoses for triad of bradypnea, miosis and loss of consciousness. Hence, body packers may sometimes be missed until they die and the packs (Figure 2) are revealed in autopsy (5,7). Perhaps a patient with miosis, relapse of bradypnea and loss of consciousness is candidate to undergo abdominal radiography or preferably abdominal computed tomography (CT) scan (Figure 3) immediately after initial stabilization (7). For cases with definite diagnosis of body packer, all packs should be irrigated with either laxative (PEG) or surgical procedure (8). Discharge of these patients predicates upon normal abdominal and pelvic CT Scan without any pack and regaining consciousness with normal respiratory rate (9).
- انتشار مقاله: 23-06-1392
- نویسندگان: Alireza Ghassemi Toussi,Gholam Ali Zare
- مشاهده