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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Antithrombins,Blood Coagulation Disorders,Dabigatran,Prescription Drug Misuse
- چکیده:
- چکیده انگلیسی: Background: Direct thrombin inhibitors and factor Xa inhibitors are gaining popularity as alternatives to warfarin for patients requiring anticoagulation. Toxicity due to these medications is difficult to manage because overdose experience is very limited and there is no clear guidance on when or whether to use antidote in this setting. Case Presentation: A 50-year-old man with normal renal function ingested 10 to 25 tablets of dabigatran 150 mg. He denied any specific symptoms and had an unremarkable physical exam. No bleeding or bruising was noted and stool was guaiac negative on initial workup. Per recommendations from the Regional Poison Center, a single 100 g dose of activated charcoal was administered approximately three hours post-ingestion and the patient was admitted for monitoring. Baseline coagulation parameters of the patient (including aPTT) revealed coagulopathy. However, no sign of systemic or local hemorrhage was detected. Having received only supportive treatments during admission, aPTT restored to normal limits by hospital day 2. A dabigatran level revealed the drug to be almost completely eliminated by 34 hours after ingestion. Discussion: Specific reversal agents for direct thrombin inhibitors are under final phases of development. The question of whether or not to use these antidotes is expected to come up in situations of accidental or intentional overdose with direct thrombin inhibitors. Similar to our observation, some scientists showed that dabigatran overdose can be managed conservatively with supportive treatments. Conclusion:This case adds to the limited pool of literature regarding dabigatran overdose and outcomes, and suggests that a patient with an overdose of this magnitude may be safely managed without acute intervention. Literature review suggests that aPTT might be an appropriate method for monitoring anticoagulant effects related to this drug in the clinical setting.
- انتشار مقاله: 09-02-1394
- نویسندگان: Rachel M. Gorodetsky,Finda Sankoh,Joe Pereira,Timothy J. Wiegand
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Overdose,Blister,Coma,Quetiapine
- چکیده:
- چکیده انگلیسی: Background: Skin lesions and blistering in the overdose patient, most notably associated with barbiturate overdoses, are commonly referred to as coma blisters, ‘barb blisters’, or ‘barb burns’. We present a patient who was noted to have skin lesions including bullae and blistering following a prolonged coma after quetiapine overdose.
Case report: A 27 year old male presented to our institution with the history of having ingested 7,200 mg of quetiapine in a suicide attempt up to 35 hours prior to being discovered. The patient was found comatose, and was noted to have multiple vesicles on his right ankle and a firm, erythematous plaque and bullae on his right thigh.
Discussion: Sequelae related to prolonged immobility of any cause may include injury to muscle, vascular, microvascular and cutaneous structures. Coma blisters differ from pressure ulcers in many ways and cannot be graded using the typical staging system. Histopathologic analysis suggests an array of microvascular injuries which are secondary to direct pressure injury as well as specific drug effect.
Conclusion: This is the first description of a dermatologic manifestation attributed to coma from isolated quetiapine overdose. Blister formation can be considered as a possible complication of quetiapine overdose.
How to cite this article: Wiegand TJ, Gorodetsky RM, Peredy TR. Coma Blisters in the Setting of Quetiapine Overdose: Case Report and Review of Literature. Asia Pac J Med Toxicol 2013;2:153-6.- انتشار مقاله: 22-08-1392
- نویسندگان: Timothy J. Wiegand,Rachel M. Gorodetsky,Tamas R. Peredy
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: rabies,Post-exposure prophylaxis,Medication shortage,Poison center,Public health
- چکیده:
- چکیده انگلیسی: Background: During the one-year period from May 2008 to May 2009, a nationwide shortage developed which rabies vaccine was not being produced by the manufacturers. In order to manage existing supply, a protocol was established wherein an authorization was required from the regional poison center before vaccine could be administered to a patient.
Methods: The Georgia Poison Center internal database was accessed for information pertaining to rabies exposure calls for the time of the restriction, as well as the years before and after. Results were examined for the total number of human rabies exposure calls received by the poison center, as well as the number of cases in which PEP was recommended.
Results: During the restriction period, the number of rabies-related calls increased, while the percentage of cases in which PEP was recommended, remained consistent. The year following the restriction, the number of rabies related calls remained elevated.
Conclusion: Our Regional Poison Center was able to make a positive impact by reducing unnecessary use of PEP in a time of shortage and thereby ensuring that all patients who needed the vaccine were able to receive it. This further shows the potential capacity of the poison information centers to optimize healthcare services.
- انتشار مقاله: 04-06-1391
- نویسندگان: Rachel M. Gorodetsky,Stephanie L. Hon,Robert J. Geller,Brent W. Morgan
- مشاهده