Severe hypokalemia secondary to abuse of ß-adrenergic agonists in a pediatric patient: Case report / Hipocalemia grave secundária a abuso de agonistas ß-adrenérgicos em paciente pediátrico: relato de caso

ABSTRACT This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of β-adrenergic agonists in the context of a probable factitious disorder.

RESUMO O presente estudo relata o caso de um jovem de 13 anos de idade com histórico, há três anos, de episódios de hipocalemia grave intermitente de origem desconhecida, internado em unidade de terapia intensiva (UTI) por síndrome do QT longo (SQTL). O paciente foi diagnosticado com hipocalemia por redistribuição secundária ao abuso de agonistas β-adrenérgicos, em contexto de provável transtorno factício.

Supraversión de la mirada en intoxicación mortal por bupropión / Sustained upgaze in a patient who ingested high doses of bupropion: report of one case

Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma. A magnetic resonance imaging done at the eighth day, showed hyperintensity of the oval center and corpus callosum which disappeared in a new imaging study done 30 days later, where images of hypoxia in the basal nuclei and cortex appeared. The patient died forty seven days after admission. Up-gaze is an ominous oculomotor alteration linked to an important but incomplete damage in the cerebral cortex, a condition that perverts some sequences of the ocular opening, reversing the Bell phenomenon and producing eyelid retraction.

Envenenamiento mortal causado por el aceite de epazote: chenopodium graveolens / Fatal poisoning caused by epazote oil: chenopodium graveolens

Se presenta el caso de una niña de 2 años y 9 meses de edad, a quien una curandera indica la administración de aceite de epazote (aceite de quenopodio) como vermífugo, en dos tomas de 20 ml cada una. Después de la segunda manifiesta coma profundo, convulciones, midriasis, apnea, acidosis metabólica, choque neurogénico y muerte. ElEEG mostró un trazo sugestivo de encefalopatía, la TAC con imagen de edema cerebral y colapso ventricular. El estudio postmortem ratificó el edema cerebral y microscópicamente evidenció necrosis neuronal difusa; otros hallazgos fueron neumonía, enteritis, peicolangitis, pancreatitis incipiente y necrosisi tubular, el análisis fitoquímico del aceite identificó ascaridol, principio activo de las quenopodáceas, en cantidad 39 mg/ml (1,560 mg en los 40 ml ingeridos) y a chenopodium graveolens como la planta de la que se obtuvo el aceite, conforme al método como históricamente se adminstraba el aceite, la paciente debió haber ingerido una dosis total de ascaridol de 60 mg, por lo que la cantidad administrada fue 26 veces superior, además que excedía 56 por ciento la dosis de 1,000 mg, informada como letal en humanos.

Deliberate self-poisoning with drugs and household products in North-Jordon: a 4-year review

To study the clinical and sociodemographic trends and determine the pattern and resources of parasuicide with drugs and household products in North Jordan. A retrospective data review. The Medical Department, Princess Basma Teaching Hospital, a 500-bed university-affiliated hospital in North Jordan. All patients aged 15 years and over, with a diagnosis of deliberate drug overdose, ingestion or poisoning, listed according to the International Classification of Diseases Ninth Revision [ICD-9] over the period January 1990 to January 1994, were included in the study. Over the indexed period 709 cases were admitted. These cases represented 8% of all acute medical admissions. The annual incidence rate was 127 cases per 100000 population. The highest rates were found among adolescents [416 cases per 100 000 in the 15-19 year age group]. There was no significant age difference for both sexes [mean +/- SD was 22.1 +/- 6.7 and 21.7 +/- 6.4 for males and females respectively] [p>0.05]. The female to male ratio was 1.4:1 and the mean length of stay in hospital was 2.7 days. Household products were the most common agents used [19%], followed by paracetamol [15%], while the most common source of the agent involved was a drug prescribed to the patient or a family member [38%], followed by household products and agricultural organophosphorus compounds available at home [23%]. A psychiatric diagnosis was made in 17% of cases and a previous suicidal attempt had been made in 10% of the cases. Twenty per cent [20%] were admitted to the medical intensive care unit [MICU]; 8% were in coma at the time of admission and four of these patients died, constituting a hospital mortality of 0.6%. The findings of this study refute the general belief that parasuicide is rare in this part of the world. Clearly it continues to be a major health problem for which effective preventive and therapeutic strategies are badly needed

Hypoglycaemia following zinc phosphide poisoning.

Two cases with severe hypoglycaemia following zinc phosphide poisoning are reported. Both patients succumbed to toxic myocarditis.