Impacto das intoxicações por antidepressivos tricíclicos comparados aos depressores do “sistema nervoso central” / Poisoning impact by tryciclic antidepressants compared to Central Nervous System depressants

Os antidepressivos tricíclicos (ADT) constituem uma classe de drogas de alta importância toxicológica,porque o uso abusivo dessa substância acarreta alguma sintomatologia ou mesmo risco de vida, pelo fácil acesso, em razão do baixo custo, da distribuição pelo sistema público de saúde e pela prescrição indiscriminada.Este trabalho teve por objetivos avaliar o impacto das intoxicações por ADT atendidos em um hospital terciário comparando com as intoxicações ocasionadas por outras drogas depressoras do “sistema nervoso central”. Para a realização deste trabalho foram avaliados os atendimentos realizados pelo Centro de Assistência Toxicológica (CEATOX) de São José do Rio Preto, entre o período de 01 de janeiro de 2001 até 31 de dezembrode 2003, através da Ficha de Notificação do CEATOX. Nesse estudo, de um total de 2950 atendimentos, 123 eram casos de intoxicação por antidepressivos tricíclicos (ADT) e 275 de outras drogas depressoras do“sistema nervoso central” (DSNC) atendidos neste hospital. O ADT mais utilizado foi a Amitriptilina; já entre os DSNC temos os Benzodiazepínicos (BZD). Houve uma maior internação por parte dos ADT, com maior tempo de internação em relação aos DSNC. Com isso, observamos o significativo impacto que as intoxicações pelos ADT causam em termos de atendimento e internação para o nosso hospital. Concluímos que os benefícios e os riscos da prescrição de ADT, hoje largamente utilizados em várias patologias, precisam ser bem avaliados, e sempre que possível, a opção por outros medicamentos com potencial toxicológico menos intenso deve ser feita.

A considerably important toxicological class of drugs is the Tryciclic antidepressants (TCA) because thedrug abuse can trigger some complex combined symptoms of a disease or even risk of death; it is easilyattainable; owing to his low cost; it is available at the health public system; and it is widely prescribed. Thisstudy directly aimed at to estimate the poisoning impact by TCA of patients treated at a tertiary hospitalcompared to poisoning caused by other central nervous system depressant drugs. To the completion of thisessay the exams performed by the Center for Toxicological Assistance (CEATOX) of São José do Rio Preto,from January 1st 2001 to December 31st 2003, were estimated by the Center for Toxicological Assistance(CEATOX) Notification Form. In this study, from a total of 2,950 treated in-hospital patients, 123 werepoisoning cases caused by tryciclic antidepressants (TCA), and 275 from other central nervous systemdepressant drugs. Amytriptiline was the most used Tryciclic antidepressant while among the central nervoussystem depressant drugs the benzodiazepine compounds were the mostly used ones. There was a higherhospitalization rate with tryciclic antidepressants but a higher length of hospitalization related to the centralnervous system depressant drugs. The hospitalization costs to the Unified Health System (SUS) werefurther analyzed indicating that the poisoning costs by tryciclic antidepressants were the same when comparedto central nervous system depressant drugs. And therewith we could see the significant impact that thepoisonings by tryciclic antidepressants caused in relation to medical attendance and hospitalization to ourhospital. It was inferred that the benefits and risks of tryciclic antidepressant prescription, nowadaysextensively used in several pathologies, need to be estimated and whenever is possible, the choice for amedication with a much less intense toxicological potential should be made.

Delayed hemodynamic monitoring with pulmonary artery catheter is a non-essential care in severe sepsis and septico shock

Objective: Prompt adequate antibiotic therapy, eradication of infection, fluids and vasoactive drugs are themain strategies for initial resuscitation of septic shock. Once initial resuscitative efforts are not effective,invasive hemodynamic monitoring (HM) with pulmonary artery catheter (PAC) has been frequently used toguide filling pressures and optimal doses of vasoactive agents. However, the evidence of benefit from PACuse in septic shock is still a matter of debate. We aimed to determine whether early compared to delayplacement of PAC could have influenced outcome.Methods: Retrospective analysis in a 24-bed general ICU tertiary care university hospital. From January 1999to December 2000, patients admitted with severe sepsis and septic shock and having a PAC inserted werestudied. Early invasive HM was defined whenever a PAC was placed in the first 48 hours, and delayedinvasive HM was placed more than 48 hours after the diagnosis of severe sepsis or septic shock. Organ failurewas defined as a SOFA score of > 3 points.Results. Among 104 patients submitted to invasive monitoring with PAC, 56 patients had sepsis. Fifty-twopatients with severe sepsis (5, 9.6 por cento) and septic shock (47, 90.4 por cento) were enrolled. Thirty-six patients (69 por cento) hadearly HM and 16 (21 por cento) delayed HM. Overall in-hospital mortality was 69 por cento. The groups had similar APACHEII score (18.6 ± 8.0, early HM; 18.5 ± 3.8, delayed HM), SOFA score (9.4 ± 3.2, early HM; 9.9 ± 4.4, delayed HM)and number of organs failure (1.6 ± 0.9, early HM; 1.8 ± 1.4, delayed HM) at the onset of severe sepsis/septicshock. The in-hospital mortality rate was significantly higher in delayed HM group (87.5 por cento) compared withearly HM (61.3 por cento) (RR: 0.70, CI 95 por cento 0.50-0.96, p < 0.05). Compared with delayed HM, early HM patientsreceived significantly higher amount of fluids (10.3 ± 3.6 L vs 6.8 ± 3.5 L, p = 0.002) within 48 hours from onsetof severe sepsis/septic shock.Conclusion. Delayed monitoring with PAC patients with severe sepsis/septic shock is associated with a veryhigh risk of death and might be considered a non-essential care.

Aspectos clínico-evolutivos e sociais decorrentes da ingestäo de raticida: um caso ilustrativo / Clinical and social aspects of rat poison ingestion: an illustrative case

Os quadros de intoxicação por raticida, a base de monofluoracetato de sódio (composto 1080), são graves,raros de diagnóstico precoce difícil e habitualmente baseiam-se na história de ingestão do veneno e achados clínicos. assim,relata-se o caso de M.S.s.,masculino,38 anos,procedente de São José do Rio Preto,que deu entrada na emergência do HB-FAMERP em 27/02/98,com história de ingestão intencional de 50ml do raticida "Mão Branca", a cerca de uma hora antes,com quadro de crise convulsiva e opistótono. Feito tratamento suporte e sintomático iniciais,encaminhou-se o paciente para UTI,evoluindo insatisfatoriamente ao final de 36 horas,apresentou parada cardíaca irreversível as manobras de ressuscitação