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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: Alcoholism,Phenobarbital,Comparative Effectiveness Research,Alcohol Withdrawal Delirium,Benzodiazepines
- چکیده:
- چکیده انگلیسی: Background: For treatment of severe alcohol withdrawal syndrome, high dose benzodiazepines (BZDs) may cause delirium and over-sedation. Phenobarbital (PBT) is a long-acting barbiturate effective for the treatment of alcohol withdrawal. Given the potential benefits of PBT, we sought to investigate the effectiveness of PBT as adjunctive treatment for alcohol withdrawal.
Methods: This was a retrospective cohort study on patients with a diagnosis of alcohol withdrawal who had a CIWA-Ar score > 10 treated with either BZDs alone (BZD alone group) or BZDs with adjunctive PBT (PBT-adjunct group). The patients received at least one dose of PBT in addition to BZDs (variable doses) in the PBT-adjunct group, and three doses of 20 mg diazepam equivalents within 6 hours in the BZD alone group. The primary endpoint was the proportion of patients with a CIWA-Ar score < 10 at 24 hours after initial treatment. Duration of withdrawal and cumulative dose of BZDs were also assessed.
Results: Seven subjects in the adjunctive phenobarbital and 21 in the benzodiazepine group were included in the final analysis. Two patients (28.6%) in the PBT-adjunct group and 5 patients (23.8%) in the BZD only group achieved the primary endpoint, though the difference between the two groups was not statistically significant (P = 0.588). The median (IQR) duration of withdrawal symptoms was 44 (12-62) hours in the PBT-adjunct group compared to 53 (37-87) hours in the BZD only group, with no significant difference between the groups (P = 0.249). The median (IQR) cumulative BZD dose requirement (diazepam equivalent) in the PBT-adjunct group was significantly lower than BZD alone group (25 (20-226) vs. 326 (160-550) mg, P = 0.02).
Conclusion: PBT appears to be a safe and effective alternative to BZDs for the treatment of alcohol withdrawal in non-critically ill patients and may be BZD sparing.- انتشار مقاله: 26-08-1393
- نویسندگان: Lauren Z. Gashlin,Christine M. Groth,Timothy J. Wiegand,Elizabeth Dodds Ashley
- 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