Comparative Analysis of Acute Toxic Poisoning in 2003 and 2011: Analysis of 3 Academic Hospitals

Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 +/- 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.

Does the Incidence of Rhabdomyolysis Induced by Doxylamine Overdose Increase in the Elderly?

BACKGROUND: Doxylamine is an over-the-counter drug that is popular in the treatment of insomnia. Doxylamine is relatively safe but can cause rhabdomyolysis. The aim of this study was to evaluate whether the incidence of rhabomyolysis increased in elderly patients (age> or =65 years) with doxylamine overdose. METHODS: This study included 108 patients admitted to an Emergency Department after doxylamine overdose between January 1, 2000, and March 31, 2013. Age, sex, time ingested before admission, amount of drug ingested, gastric lavage, tachycardia, vomiting, hematuria, blood urea nitrogen, blood creatinine, urine pH, and alcohol ingestion were investigated for the risk factors of rhabdomyolysis. RESULTS: Forty-three patients (47.6%) developed rhabdomyolysis. Of 16 elderly patients, 11 developed rhabdomyolysis. Of the 92 patients <65 years-of-age, 34 developed rhabdomyolysis. Advanced age, alcohol ingestion, and increased blood creatinine level were significantly associated with the development of rhabdomyolysis. CONCLUSION: In elderly patients with doxylamine overdose, the incidence rate of rhabdomyolysis may be increased. A high index of suspicion and evaluation of rhabdomyolysis is warranted in elderly patients with doxylamine overdose.

Simultaneous determination of clobutinol hydrochloride and doxylamine succinate from syrups by RP HPLC using a new stationary phase containing embedded urea polar groups

A new, simple, fast, reproducible and sensitive reversed phase HPLC method, using a new stationary phase containing embedded urea polar groups, has been developed and validated for the simultaneous determination of clobutinol hydrochloride (CLO) and doxylamine succinate (DOX) in syrups. The determination was carried out on a C8 urea column (125 mm x 3.9 mm i.d., 5 µm particle size) synthetized at the Liquid Chomatography Laboratory (LabCrom) of the Chemistry Institute of Unicamp. The mobile phase consisted of a mixture of acetonitrile:methanol:phosphate buffer (pH 2.5) in the gradient mode. The diode array detector (DAD) was operated at 230 nm for CLO and 262 nm for DOX. The method showed adequate precision, with relative standard deviations (RSD) less than 1%. The presence of the excipients did not interfere in the results of the analysis. Accuracy was determined by adding standards of the drugs to a placebo and good recovery values were obtained. The analytical curves were linear (r² 0.9999 for CLO and 0.9998 for DOX) over a wide concentration range (2.4-336 µg mL-1 for CLO and 2.3-63 µg mL-1 for DOX). The solutions were stable for at least 72 hours at room temperature. The criteria for validation using the ICH guidelines were fulfilled.

Um novo método simples, fácil e reprodutível, de fase reversa para CLAE, usando uma fase estacionária contendo um grupo polar, uréia, embutido, foi desenvolvido e validado para determinação simultânea de cloridrato de clobutinol (CLO) e succinato de doxilamina (DOX) em xarope. A determinação foi realizada em uma coluna C8 uréia (125 mm x 3,9 mm d.i., 5 µm tamanho de partícula) sintetizada em nosso laboratório (LabCrom). A fase móvel consistiu de mistura de acetonitrila:metanol:tampão fosfato pH 2,5, em eluição por gradiente. O detector por arranjos de diodo (DAD) foi utilizado a 230 nm para CLO e a 262 nm para DOX. O método apresentou precisão adequada, com desvio padrão relativo menor que 1%. A presença de excipientes não interferiu nos resultados obtidos. A exatidão foi realizada pela adição dos padrões dos fármacos ao placebo e valores de recuperação aceitáveis foram obtidos. As curvas analíticas mostraram-se lineares (r² 0,9999 para CLO e 0,9998 para DOX) em uma ampla faixa de concentração (2,4-336 µg mL-1 para CLO e 2,3-63 µg mL-1 para DOX). A solução padrão foi estável por 72 horas a temperatura ambiente. Os parâmetros de validação foram realizados conforme o guia ICH.

The Relationship between Rhabdomyolysis and Alcohol Ingestion in Doxylamine Intoxicated Patients

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.

Nausea and Vomiting in Pregnancy / 대한내과학회지

Nausea and vomiting in pregnancy (NVP) is common medical condition during pregnancy and associated with hormonal change. Early recognition and active treatment is warranted because it can be associated with adverse healthy effect in both fetus and mother. First, the possibility of other gastrointestinal disorder should be considered and precipitating factor, renal and liver function should be evaluated. Primay recommended pharmacotherapy is the combination of oral pyridoxine hydrochloride and doxylamine succinate. Other options including dopamin (D2) receptor antagonist, antihistamine and serotonine 5 hydroxytryptamine 3-receptor (5-HT3) can be used. Fluid mixed with multivitamine including thiamine supplement should be considered in case of severe dehydration and hyperemesis gravidarum. Emotional support is also an important part in the management of NVP. The physician shoud apply individualized approach for the safest and most appripriate treatment.

Náuseas y vómitos durante el embarazo / Nausea and vomiting during pregnancy

Se hace una revisión de la etiología, fisiopatología y factores de riesgo de las náuseas y vómitos que ocurren durante el embarazo, así como del impacto, en casos severos o persistentes, en la salud de la madre, y del feto y del recién nacido. Se revisan los tratamientos propuestos, farmacológicos unos, no farmacológicos otros, resaltando el evidente beneficio terapéutico de la combinación de piridoxina con doxilamina y la evidencia de su inocuidad, que estuvo en entredicho a principio de la década de 1980...

Comparative Analysis of Overdose with Common Sleep-aid Medications: Doxylamine vs Diphenhydramine

PURPOSE: The previous studies on H1 antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. METHODS: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). RESULTS: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. CONCLUSION: Two common H1 antihistamines, doxylamine and diphenhydramine, are in the same ethanolaminestructural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.

The Clinical Features and Risk Factors of Seizure After Doxylamine Intoxication

PURPOSE: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. METHODS: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients' age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. RESULTS: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. CONCLUSION: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.

Drug induced Pulmonary Edema

PURPOSE: Drug-induced non-cardiogenic pulmonary edema has been reported on in a drug case series. For most of the agents that cause pulmonary edema, the pathogenic mechanisms that are responsible for the pulmonary edema remain unknown. We report here on the cases of suspected drug-induced pulmonary edema and we analyze the clinical characteristics. METHODS: We reviewed the medical records of 1,345 patients who had drug adverse effects and drug poisoning from January 2005 to July 2010, and 480 of these patients were admitted to the EM Department. Among them, 17 patients developed abnormal chest radiological findings and they were analyzed for any clinical characteristics, the initial symptoms, securing the airway and the clinical results. RESULTS: Seventeen patients out of 480 (3.54%) developed drug-induced abnormal chest radiographic pulmonary edema; they displayed initial symptoms that included mental change (41.2%), dyspnea (17.6%), vomiting (11.8%), etc, and some displayed no symptoms at all (11.8%). Only 3 patients out of the 11 who died or had severe pulmonary edema were able to obtain an advanced airway prior to their arrival to the EM Department. Clinical recovery was generally rapid and this was mostly completed within 6 hours. The mortality rate was 11.8% (2 of 17 patients), and the causative drugs were found to be propofol (35.3%, 6 of 17 patients), multiple drugs (41.2% or 7 out of 17) and one patient each with ephedrine, ethylene glycol, doxylamine and an unknown drug, respectively. CONCLUSION: Drug-induced pulmonary edema and deaths are not uncommon, and recovery is typically rapid with few long-term sequelae when drug administration is discontinued. Oxygen therapy and securing the airway must be performed during transportation for patients with pulmonary edema.

The Relationship of Plasma Concentration of Doxylamine and Rhabdomyolysis in Doxylamine Overdose

PURPOSE: The relationship between plasma concentration of doxylamine and rhabdomyolysis in doxylamine overdose has not yet been reported. The aim of this study was to determine if the plasma concentration of doxylamine can predict the occurrence of rhabdomyolysis. METHODS: We reviewed the medical records of patients whose plasma concentration of doxylamine were checked during a state of doxylamine overdose. Variables, including the measured concentration (Ct) of drug, were compared between the rhabdomyolysis and the non-rhabdomyolysis group. We calculated the hypothetical initial concentration (C0) based on first order pharmacokinetics and measurement of each patient's plasma concentration of doxylamine (Ct). C0 values were compared based on the occurrence of rhabdomyolysis. RESULTS: A total of 41 blood samples were taken; all were taken more than two hours after the ingestion of doxylamine. Of the 41, 14 of the subjects showed rhabdomyolysis and 15 of the subjects did not. The rest were excluded from the study. Average values of Ct and C0 in the rhabdomyolysis and non-rhabdomyolysis groups were, respectively, 4.18+/-5.17 mg/L Vs 4.18+/-2.23 mg/L, for Ct; 6.21+/-7.92 mg/L Vs 15.53+/-17.97 mg/L for C0. Ct levels between the two groups were not different (p=1.00), but the difference in C0 was marginally significant (p=0.08). Blood sampling time showed a significant difference between the two groups (p=0.03). CONCLUSION: We can not confirm a relationship of plasma doxylamine concentration and rhabdomyolysis but it appears that the development of rhabdomyolysis in doxylamine overdose has a tendency to increase at high plasma concentration.

Clinical Features of the Patients with Seizures after Doxylamine Succinate Overdose / 대한간질학회지

PURPOSE: Doxylamine succinate is an over-the-counter drug commonly used in the treatment of insomnia. It is in the ethanolamine class of antihistamine and is frequently involved in intentional overdoses. Seizures are uncommon, but there are potentially serious complications, making early recognition and treatment essential. METHODS: We reviewed retrospectively the medical records of patients admitted for seizures after a doxylamine succinate overdose from Jan. 1, 1992 to Dec. 31, 2008. We evaluated them with respect to age, sex, amount ingested, clinical symptomatology, time from ingestion to seizure, complication, and prognosis. RESULTS: Among the 146 doxylamine overdose patients, 11 patients developed seizures. Females accounted for 9 (81.8%) patients and the number aged between 20 and 40 years was also 9 cases (81.8%). The average time from ingestion to emergency room visit was 170 minutes (60-360). The average time from ingestion to development of seizures was 188 minutes (60-480). The amount of doxylamine succinate ingested was 750-4,750 mg (mean = 2,425 mg). The frequent anticholinergic symptoms were tachycardia (63.6%), vomiting (45.5%), mydriasis (36.4%), and hypertension (36.4%). Rhabdomyolysis and drug induced hepatitis were observed in 7 cases (63.6%) and 6 cases (54.5%), respectively. Primary treatment included administration of benzodiazepine and conservative care. After more than a 6 month follow-up, no patients developed further seizure. CONCLUSIONS: The incidence of seizure after doxylamine succinate overdose is uncommon and prognosis is good. However, other serious symptoms are commonly combined, and we have to be aware that seizures are a potential complication and should be actively investigated and vigorously treated.

The Predictive Factors of the Serum Creatine Kinase Level Normalization Time in Patients with Rhabdomyolysis due to Doxylamine Ingestion

PURPOSE: Doxylamine succinate (DS) is frequently used to treat insomnia and it may induce rhabdomyolysis in the overdose cases. The purpose of this study is to evaluate the factors that can predict the serum creatine kinase (CK) level normalization time for patients with rhabdomyolysis due to DS ingestion. METHODS: This study was conducted on 71 patients who were admitted with rhabdomyolysis after DS ingestion during the period from January 2000 to July 2009. Rhabdomyolysis was defined as a serum CK level over 1,000 U/L. The collected data included the general characteristics, the anticholinergic symptoms, the ingested dose, the peak serum CK level, the time interval (TI) from the event to the peak CK level and the TI from the event to a CK level below 1,000 U/L. We evaluated the correlation between the patients'variables and the TI from the event to the peak CK level time and the time for a CK level below 1,000 U/L. RESULTS: The mean ingested dose per body weight (BW) was 30.86+/-18.63 mg/kg and the mean TI from the event to treatment was 4.04+/-3.67 hours. The TI from the event to the peak CK level was longer for the patients with a larger ingestion dose per BW (r=0.587, p<0.05). The CK normalization time was longer for the patients with a larger ingested dose per BW (r=0.446, p<0.05) and a higher peak CK level (r=0.634, p<0.05). CONCLUSION: The ingested dose per BW was correlated with the TI from the event to the peak CK level, and the ingested dose per BW and the peak CK level have significant correlations with the CK normalization time. These factors may be used to determine the discharge period of patients who had rhabdomyolysis following a DS overdose.

Les medicaments des nausees et vomissements au cours de la grossesse

La nausee et les vomissements sont frequents au cours de la grossesse. Ces manifestations sont en general benignes mais elles peuvent occasionner des consultations medicales qui aboutissent le plus souvent a des cas des conseils rassurants precis et repetes; une alimentation fractionnee; permettent de se passer de medicaments. Au cas ou le besoin de prescription s'impose; voici quelques reperes qui permettent de hierarchiser les interventions

Is There Any Relationship Between Hematuria in Rhabdomyolysis and Renal Injury?

PURPOSE: In previous literature, urinalysis in rhabdomyolysis has been known to be positive for occult blood, but without overt hematuria. Recently, however, we have reported hematuria in patients with doxylamine overdose in association with rhabdomyolysis. We wanted to determine whether the hematuria resulted from the toxicity of doxylamine itself or from rhabdomyolysis, and further to investigate the relationship between hematuria, acute renal failure (ARF), and the presence of urine alkalinization. METHODS: The medical records of 167 patients diagnosed with rhabdomyolysis who were admitted to Kyung Hee Medical Center between 2000 and 2004 were retrospectively examined. Patients without laboratory results 3 times a day, patients with inaccurate records, and patients with diseases that could cause hematuria were excluded, leaving 79 patients for evaluation. The relationship between laboratory results, occurrences of ARF and urine alkalinization were compared and assessed. RESULTS: Hematuria was observed in 76 of 79 patients with rhabdomyolysis, irrespective to the cause of rhabdomyolysis. The percentage of dysmorphic RBC was 58% and MCV (mean corpuscular volume) was 76+/-15 fL found in hematuria. Urine alkalinization was not associated with the presence of hematuria. The laboratory results of ARF patients compared to those of non-ARF patients showed a significant difference in the average urine pH, and ARF with rhabdomyolysis was not associated with muscle enzyme levels but rather was associated with the duration of hematuria. CONCLUSION: Hematuria was found in patients with rhabdomyolysis irrespective of the cause of rhabdomyolysis. Therefore, hematuria is associated with rhabdomyolysis rather than doxylamine intoxication. The occurrence of hematuria in rhabdomyolysis is unrelated to urine alkalinization. The duration of hematuria in ARF group was significantly longer than in non-ARF group. It is therefore important to bear in mind the possibility that ARF will develop when hematuria lasts for a long time. Furthermore, we feel that additional prospective studies and investigations into the mechanism of hematuria in rhabdomyolysis should be done.

The Relation between Rhabdomyolysis and Microscopic Hematuria in Doxylamine Ingested Patients / 대한신장학회잡지

BACKGROUND: Doxylamine is the most commonly intoxicated drug in the emergency room. This drug is relatively safe but is known to induce rhabdomyolysis and acute renal failure in rare occasions. We found the presence of microscopic hematuria in doxylamine intoxicated patients. But no previous studies have documented this hematuria. Our objectives of this study were to determine the incidence of microscopic hematuria after doxylamine overdose and to find the prognostic factors that contribute to this complication. METHODS: This study was conducted from 22 patients admitted to Kyung Hee Medical Center after doxylamine intoxication during the period from January 2001 to December 2003. Using the protocol made beforehand, the amount ingested, past history and laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase (CK) over 1, 000 IU/L. Data were analyzed using SPSS program with t- test, Fisher's exact test and discriminant analysis. RESULTS: The microscopic hematuria was detected in 63.6% of patients. The amount ingested per body weight, presence of rhabdomyolysis and the time when the muscle enzymes reach highest level were related to the hematuria. CONCLUSION: The incidence of microscopic hematuria was higher when more than 30 mg per body weight of doxylamine was ingested than less this amount. Microscopic hematuria suggests the presence of kidney and urinary tract injury. Urine pH of hematuria is over 7.5. Our findings provide no support for the belief that the ferrihemate injures the kidney of doxylamine ingested patients.

Predictors of High Peak Serum CK Levels in Doxylamine Intoxication

BACKGROUND: Because doxylamine succinate (DS) is an over-the-counter medicine, it can be obtained easily and is frequently used in suicidal attempts. Patients usually recover without serious complications, but occasionally rhabdomyolysis and even death can occur in DS intoxication. In this study, the authors tried to find out the independent predictors of high peak serum CK levels, i.e. probable rhabdomyolysis in DS intoxication. METHODS: The medical records of 41 patients who visited a hospital for DS intoxication from January 1, 2002 to April 30, 2003, were reviewed retrospectively. RESULTS: In the group of DS only, initial occult blood of urine (P=0.003), initial WBC count (P=0.003) and confusion (P=0.007) were the best predictors of the peak serum CK level (2=0.724). In the group of DS with other drugs intoxication, initial creatinine level (P=0.003) and initial occult blood of urine (P=0.007) were the best predictors of the peak serum CK level (r2=0.784). In the cases of rhabdomyolysis patients, the time taken for the CK level to be increased over 1,000 IU/L was 1.9level to be increased over 1,000 IU/L was 1.9+/-0.6 days. CONCLUSION: In DS only intoxication, occult blood in initial urine analysis, initial high WBC count and confusion can be thought of as useful clinical predictors for high peak serum CK level case. In DS with other drugs intoxication, initial creatinine level and initial occult blood of urine can be considered as the best predictors. More than 2 days will be needed for the observation of serious complications in DS intoxication.

Endoscopic Evaluation of Upper Gastrointestinal Injury in Patients with Noncaustic Drug Ingestion

PURPOSE: There have been few studies of the direct effect of a drug overdose on the gastrointestinal (GI) mucosa. This study evaluated the frequency of GI mucosal injury and the necessity for esophagogastroduodenoscopy (EGD) in patients with non-caustic drug ingestion (DI). METHODS: Patients who presented to the emergency department with non-caustic DI from January 2001 to December 2003 were enrolled in this study. EGD was performed on the patients after acute toxicologic management. Those who did not consent to EGD were excluded. The EGD findings were analyzed according to the non-caustic drug that had been ingested. RESULTS: Among the 37 patients, 24 (65%) had significant endoscopic lesions. Endoscopic findings were gastric erosion (n=17), ulcers (n=5), esophageal erosion (n=1), and a gastric hemorrhage (n=1). Pesticides, rodenticides, salicylates, and high dose doxylamine (>5 g) were associated with drug-induced gastropathy. CONCLUSION: This study suggests that GI mucosal injury has been underestimated in DI patients and that a treatment for gastromucosal protection should be performed when the non-caustic ingested drug is a pesticides, a rodenticides, a salicylates or high-dose doxylamine.

Treatment of the common cold.

BACKGROUND: Common colds are usually treated by the patients themselves with over-the-counter (OTC) cold medications. Many cough and cold remedies are available and sold freely without prescription. The authors conducted a study to compare the efficacy, adverse effects, the quality of life (QOL) and the patient's opinion and appreciation on the drugs (POD) between Dayquil/Nyquil and Actifed DM plus paracetamol syrup. METHOD: In this prospective, investigator-blinded clinical trial, 120 patients, aged between 15 and 60 years old, with common colds within 72 hours, who accepted the trial and gave informed written consent, were randomized into two treatment groups. One patient was excluded due to evidence of bacterial infection. Fifty-nine patients were treated with Dayquil/Nyquil (D/N group), while the other 60 patients had Actifed DM plus paracetamol (ADM/P group) for three days. On day 1 the patient's demographic data (sex, age, body weight, blood pressure, co-existing diseases/conditions, drug use, and allergy to any drugs), the most prominent symptoms and its duration were recorded. All patients were screened for bacterial infection by physical examination, complete blood count and sinus radiographs. The symptoms (nasal obstruction, rhinorrhea, sneezing, cough, sore throat, fever and headache) and signs (injected nasal mucosa, nasal discharge and pharyngeal discharge) were scored, based on 4-point scale (0 to 3), on days 1 and 4. Changing of the symptoms and QOL were recorded on the diary card. The patient's opinion and appreciation on the drugs (POD) was assessed on day 4. The effectiveness (the ability to lessen the symptoms and signs), QOL and POD between two treatments were compared. RESULTS: The demographic data between the two groups were similar. The four most common prominent symptoms of common colds in our series were cough (47.9%), sore throat (26.17%), rhinorrhea (8.4%) and headache (8.4%). However, both treatments were equally effective in lessening the symptoms (P = 0.426) and signs (P = 0.716) of common cold from days 1 to 4. The adverse effects were significantly higher in ADM/P group than in D/N group (p = 0.006). In contrast, QOL in terms of alertness, freshness and sound sleep improved from day 1 to day 3 in both treatments, but the overall day-3 score was significantly higher in the D/N group than the ADM/P group (1.85 +/- 1.83; 1.25 +/- 1.94: p = 0.024). POD in terms of convenience, flavour of drug, effectiveness of the drug and a need to repeat the drug assessed on day 4, was also significantly higher in the D/N group than the ADM/P group (10.68 +/- 2.56; 8.92 +/- 2.27: p < 0.001). CONCLUSION: Dayquil/Nyquil are as effective as Actifed DM plus paracetamol in controlling the symptoms and signs of the common cold, but have fewer adverse effects. The quality of life assessed during the use of the drugs was significantly higher in the Dayquil/Nyquil group, and according to the patients, they prefered Dayquil/Nyquil more than Actifed DM plus paracetamol.

The Effect of Separation of Prescription and Dispensation of Drugs on Acute Poisoning in Urban Tertiary Emergency Center

PURPOSE: The separation of prescription and dispensation of drugs starting from July 2000 has led to a reduced exposure to drugs for the general population. Therefore, we hypothesize that the policy of separation the prescribing and the dispensing of drugs has decreased the actual incidence of drug intoxication from drug abuse. METHODS: Patients with acute intentional drug intoxication who were admitted to emergency centers in Seoul were retrospectively studied. The study period was subdivided into three: before, during, and after the launch of the policy of separation of prescription and dispensation, corresponding to the periods January to June, 2000; January to June 2001; and January to June 2002, respectively. RESULTS: Acute drug intoxication was associated with 0.2% of all prescriptions during the studied period. There was no significant difference in the types of intoxicating drugs whereas the most commonly abused drug was Doxylamine succinate. Prescribed medications accounted for 37.0%, 29.2%, and 32.3% of the acute drug intoxication cases in 2000, 2001, and 2002, respectively. There was no significant difference in the treatment outcomes between the three study groups although three patients died of paraquat intoxications in 2001. CONCLUSION: The launch of the policy of separation of prescription and dispension of drugs did not significantly reduce the rate of acute drug intoxication from drug abuse which questions the effectiveness of the policy in decreasing drug abuse. We suggest reassessment of sedatives, in particular, those prescribed medications, in order to decrease the incidence of acute intoxications.

A Case of Severe Rhabdomyolysis with Acute Renal Failure after Doxylamine Overdose / 대한신장학회잡지

Doxylamine succinate is an over-the-counter drug widely used for treating insomnia. We experienced a case of severe rhabdomyolysis complicating acute renal failure after doxylamine overdose in a 24-year- old male. The maximum values of creatine kinase and creatinine level during hospitalization were 264,141 IU/L and 8.4 mg/dL, respectively. Oliguria and severe dyspnea occurred on the sixth hospital day and were treated with hemodialysis. Then, he recovered without any sequelae. To the best of our knowledge, the maximum creatine kinase level of 264,141 IU/L in the present case is the highest value among the case reports on doxylamine-induced rhabdomyolysis and this is the first case report in Korea of doxylamine-induced severe rhabdomyolysis accompanying oliguric acute renal failure and requiring treatment with hemodialysis.