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Potential Prognostic Roles of Serum Lactate and Creatine Kinase Levels in Poisoned Patients
Background Examination of serum lactate Level and its changes, as an indicator of tissue oxygenation, as well as level of creatine kinase (CK) inhibitors, as a factor of mortality which partially expresses heart, brain, and muscle damage, may be considered as tools to determine prognosis in critically ill patients. We aimed to evaluate these two factors as potential prognostic factors in critically poisoned patients admitted to our toxicology ICU.Method This is a cross-sectional descriptive-analytic study that was performed on poisoned patients referred to emergency department of Loghman Hakim Hospital. Those critically poisoned patients who were admitted to ICU were conveniently chosen and included into the study after obtaining written consent forms form their next of kin. Their serum lactate and CK levels were checked on admission. These levels were compared subsequently between survivors and non-survivors to seek for their potential prognostic role.Results In a total of 100 pati...
Adult Toxicology in Critical Care: Part II: Specific Poisonings
Chest, 2003
ABCs ϭ airway, breathing, circulation; CCB ϭ calcium-channel blocker; DNS ϭ delayed neuropsychiatric sequelae; FDA ϭ US Food and Drug Administration; GABA ϭ ␥-aminobutyric acid; GHB ϭ ␥-hydroxybutyrate; MAO ϭ monoamine oxidase; NAPQI ϭ n-acetyl-p-benzoquinonimine; SSRI ϭ selective serotonin re-uptake inhibitor Acetaminophen
Evaluation of Hyperkalemia Associated with Trimethoprim-Sulfamethoxazole in the Intensive Care Unit
Journal of Critical and Intensive Care, 2021
Aim: The objective of this study was to determine the incidence and risk factors of hyperkalemia associated with trimethoprim-sulfamethoxazole (TMP-SMX) in the intensive care unit (ICU). Study design: A single-center, retrospective observational study. Materials and Methods: The study population consisted of patients who received TMP-SMX in the ICU. Patients were categorized into two groups based on the level of serum potassium: the group with hyperkalemia and the group without hyperkalemia. Results: The incidence of hyperkalemia in the patients receiving TMP-SMX in ICU was 49% (25/51). Hyperkalemia occurred 6.2±3.8 days after the beginning of TMP-SMX treatment. Baseline serum potassium level determined as an independent risk factor for hyperkalemia (p<0.009). The optimal cutoff value of baseline serum potassium to predict hyperkalemia associated with TMP-SMX was 3.55 mEq/L. Conclusion: Potassium levels should be closely monitored, especially in the first week of TMP treatment, in critically ill patients. Even if the baseline potassium level is within normal limits, care should be taken in terms of hyperkalemia. In addition, even if hyperkalemia is mild, potassium-lowering therapeutic approaches may be necessary.
Colchicine intoxication: a report of two suicide cases
Therapeutics and Clinical Risk Management, 2013
Colchicine, an old and well-known drug, is an alkaloid extracted from Colchicum autumnale and related species. Colchicine inhibits the deposition of uric acid crystals and is an inhibitor of mitosis. Nausea, vomiting, abdominal pain, and diarrhea, with a massive loss of fluid and electrolytes are the first clinical symptoms of colchicine poisoning. Stomach lavage and rapid gastric decontamination with activated charcoal are crucial. An acute dose of about 0.8 mg/kg of colchicine is presumed to be fatal. We report the clinical outcomes of two different cases of colchicine intoxication for attempted suicide. The dose required for morbidity or mortality varies significantly. The dose of 1 mg/kg in the first case was directly related with mortality, while the dose of 0.2 mg/kg in the second was related with survival. The other difference between the patients was the time of arrival to hospital after ingestion. This period was 4 hours for case 1 and only 1, hour for case 2. The initiation of treatment later than 2 hours after ingestion of colchicine may significantly impair treatment because the absorption time for colchicine after oral administration is about 30-120 minutes. The rising lactate level and high anion gap metabolic acidosis in our patient (case 1) were attributed to lactic acidosis, so hemodialysis was performed, and the duration of hemodialysis was prolonged. Lactic acidosis in the first case was one of the reasons for mortality. The most important parameters which define the chance of survival are the dose of ingested drugs and the arrival time to hospital after ingestion. The patients must be monitored closely for lactic acidosis and the decision to start hemodialysis must be made promptly for patients who develop lactic acidosis.
Toxicology in the critically ill patient
Clinics in Chest Medicine, 2003
General approach to the intoxicated patient The protean nature of intoxications leads to potential misdiagnosis. Therefore, a high index of suspicion for intoxication is warranted in critical care medicine. Identification of a toxidrome further helps in this regard (Table 1).
Hyperkalemia in Hospitalized Patients
Archives of Internal Medicine, 1998
Background: Hyperkalemia is a common, potentially life-threatening disorder. Electrocardiograms are con- sidered to be sensitive indicators of the presence of hy- perkalemia. Since the treatment of hyperkalemia in- volves relatively few maneuvers and because its success can be objectively scored, we investigated how physi- cians manage this disorder and how successful their pre- scribed therapy is. We also sought to
Emergency Medicine Clinics of North America, 2008
Critically poisoned patients are commonly encountered in emergency medicine. Exposure to potential toxins can occur by either accident (ie, occupational incidents or medication interactions) or intentionally (ie, substance abuse or intentional overdose). The outcome following a poisoning depends on numerous factors, such as the type of substance, the dose, the time from exposure to presentation to a health care facility, and the pre-existing health status of the patient. If a poisoning is recognized early and appropriate supportive care is initiated quickly, most patient outcomes are favorable. In modern hospitals with access to life support equipment the case fatality rate for self-poisonings is approximately 0.5%, but this can be as high as 10% to 20% in the developing world lacking critical care resources [1]. This article introduces the basic concepts for the initial approach to the critically poisoned patient and the steps required for stabilization. It introduces some key concepts in diagnosing the poisoning, using clinical clues and ancillary testing (ie, laboratory, ECG, and radiology). Finally, specific management issues are discussed.