Attempted suicide by massive insulin injection: a case report and review of the literature.

The authors present a case of an 80-year-old man, non-diabetic, who attempted suicide by injecting himself subcutaneously with 10,000 units of Humulin R and 6000 units of Humulin N. Administration of dextrose intravenously was required for 13 days to maintain the capillary blood glucose within the range of 100-180 mg/dl. Hyponatremia, hypokalemia, hypophosphatemia, and elevated liver enzymes were also seen after massive insulin injection. Glucose requirement index was established to demonstrate the trend of glucose requirement during hospitalization. He recovered completely without any complication after monitoring blood glucose and titrating intravenous glucose carefully for two weeks. Current literature about how to manage insulin overdose was reviewed in the present article.

Life-threatening overdose with lamotrigine, citalopram, and chlorpheniramine.

Lamotrigine is a commonly used agent for seizure control in epilepsy. There are limited data on the adverse effects of lamotrigine in overdose. We report a number of serious side-effects associated with a large overdose of lamotrigine. A 23-year-old female presented to the emergency department after taking an intentional overdose of 9.2 g of lamotrigine, 56 mg of chlorpheniramine, and 220 mg of citalopram. On admission, she had a reduced level of consciousness and electrocardiographic abnormalities; a widened QRS and a prolonged corrected QT (QTc) interval. Prompt treatment with early intubation, along with the use of magnesium for cardioprotection and administration of sodium bicarbonate may have aided in a quick recovery with a short intensive care stay and good outcome.

Successful treatment of intrathecal morphine overdose.

A 47-year-old woman was diagnosed with secondary progressive multiple sclerosis, and was treated with intrathecal morphine for chronic pain via a slow-release subcutaneous pump. She accidentally received a 35-ml (510 mg) bolus injection of morphine by this route, which led to status epilepticus. She was treated with continuous intravenous naloxone infusion, and with medication to control hypertension and stop the seizure activity. The outcome was excellent, and the patient returned to her neurological baseline. This report describes the complications and the successful treatment of intrathecal morphine overdose. In order to prevent these serious errors, it is vital that only care providers who are proficient with these devices perform the refilling procedure.

Intoxicación aguda por hierro en un caso / Acute iron poisoning: report of case

The ingestion of iron-containing products is a potential toxicological emergency. It is a leading cause of pediatric unintentional ingestion fatalities because some iron-containing compounds are readily available (vitamin mixtures, iron pills). Among adults, it has been described as accidental overdoses (mainly in pregnancy) and as suicidal attempts. We report a 42 years old woman, admitted due to the intentional ingestion of iron pills with suicidal purposes. A plain abdominal X ray showed at least 20 pills in the gastric fundus and antrum. She was successfully treated with intravenous desferroxamine chelation. Plain abdominal X ray examination can be very useful in the diagnosis of acute iron poisoning

Manejo de la intoxicación por digitálicos / Management of digitalic intoxication

La intoxicación por digitálicos en pediatría es poco frecuente, pero sus manifestaciones y complicaciones ponen en riesgo la vida del paciente, por lo que es fundamental un diagnóstico precoz y un manejo adecuado. Es importante destacar que el espectro de pacientes en que se presenta es muy variado, desde niños que accidentalmente ingieren este medicamento, hasta pacientes cardiópatas con ingesta crónica de estos medicamentos. En estos últimos, dado el estrecho margen terapéutico y condiciones propias del paciente, pueden tener manifestaciones de toxicidad aun en las dosis recomendadas

Overdose por cocaína - uma revisäo crítica / Cocaine overdose - a critical review

A taxa de mortalidade entre usuários de droga é mais alta do que na populaçäo geral e está relacionada a overdose, tanto acidental quanto deliberada, a doenças fatais, tais como Aids, acidentes e homicídio. Overdose é o fator mais diretamente relacionada ao uso de droga. Apesar das taxas de mortalidade relacionadas ao uso de cocaína variarem entre os países, a disseminaçäo do seu uso coloca overdose por cocaína como um assunto importante para os profissionais de saúde. Esta revisäo é baseada na identificaçäo sistemática de estudos relevantes através do uso do banco de dados do MEDLINE. Ela fornece uma revisäo crítica das informaçöes à respeito da prevalência de overdose por cocaína, suas características clínicas, fatores que podem predispor a ela e princípios de tratamento.

Efficacy of flumazenil in the management of benzodiazepine overdose

Benzodiazepine overdose is the most commonly encountered drug overdose in Iran. It has been reported by many authors that flumazenil possesses highly specific antagonistic activity on central benzodiazepine receptors. We conducted a prospective study on 150 patients brought to the toxicology emergency ward in Loghman-Hakim hospital with benzodiazepine overdose to assess the efficacy of flumazenil to counteract benzodiazepine overdose. Upon arrival, patients were examined thoroughly and their Glasgow coma scale was recorded. Afterwards flumazenil was administered in sufficient dosage, between 0.25-0.50 mg. The most commonly consumed benzodiazepine was diazepam [50%]. One hundred and thirty patients responded positively to flumazenil, characterized by improved response to painful stimuli, and decreased amnesia. Twenty% of the patients [26 cases] had an increased respiratory rate after flumazenil administration. In 86 patients, consciousness improved after 5 minutes, in 36 patients after 10 minutes and in 8 patients after 15 minutes. In 48 patients the psychomotor performance improved 5 minutes after antidote administration, while in 15 patients psychomotor performance improved after 30 minutes. Some patients developed resedation after flumazenil administration. In 25 patients resedation occurred after 15 minutes, in 59 patients after 30 minutes, and 34 patients showed this phenomenon after 45 minutes. Despite this last finding, we concluded that flumazenil effectively and rapidly antagonizes the central effects of benzodiazepines. It is also a valuable diagnostic agent with no serious side effects

Tissue magnesium content and histopathological changes in non-survivors of aluminium phosphide poisoning.

The study was conducted in 30 non-survivors of Aluminium Phosphide poisoning and similar number of age and sex matched controls (fatalities as a result of road side accidents, head injury, etc). Magnesium content was estimated in brain, heart, stomach, kidney, liver and lung using atomic absorption spectrophotometer. It was found that tissue magnesium levels were not significantly different (p = NS) when comparison was carried out between controls (Group II) and Patients who were not given magnesium as part of treatment (group IB). However magnesium levels in different organs of patients who received magnesium as part of treatment were found to be significantly higher (group IA)(P < 0.01) in comparison to controls as well as patient group not treated with magnesium sulphate. Significant histopathological changes were observed in almost all the organs. The changes seem to be the result of direct tissue damage by phosphine rather than shock and anoxia which occurred in all these cases.

Incidence of intermediate syndrome in organophosphorous poisoning.

Seventy two patients admitted to the Intensive Care Unit following ingestion of organophosphorus compounds were studied prospectively with two different doses of pralidoxime (PAM). One group received 1 gm immediately after admission and no further PAM and the other group received infusion of PAM, 1 gm 8 hourly for four days (total 12 gms). The incidence of type II paralysis or intermediate syndrome was 47%. We observed a higher incidence in the 4 days of infusion of PAM group (61%) (20 patients) as compared to the single Bolus dose group (39%) (13 patients). Relative risk 1.48 (confidence interval = 0.9-2.4).

Intoxicaçäo por antidepressivos: uma revisäo / Antidepressant intoxication: a review

Os autores realizaram uma revisäo de informaçöes e artigos, a respeito dos antidepressivos, mostrando além de características gerais, descriçöes de suas respectivas intoxicaçoes e tratamentos, na certeza de que a ausência de terapêutica específica, o reconhecimento do quadro e a rápida instauraçäo de medidas de suporte adequadas seräo de grande valia