ABSTRACT
This article is intended for clinicians treating neurotoxic emergencies. Presented are causative agents of neurotoxic emergencies, many of which are easily mistaken for acute psychiatric disorders. Understanding the wide variety of agents responsible for neurotoxic emergencies and the neurotransmitter interactions involved will help the psychiatrist identify and treat this challenging population.
Subject(s)
Emergency Services, Psychiatric , Mental Disorders/chemically induced , Psychotropic Drugs/toxicity , Xenobiotics/toxicity , Decontamination/methods , Humans , Mental Disorders/diagnosis , Mental Disorders/drug therapy , Mental Disorders/therapy , Synaptic Transmission/drug effectsABSTRACT
Neurotoxic emergencies are depicted by severe disruption of critical central or peripheral nervous system functions caused by xenobiotics with rapid mechanisms of action. This article reviews 4 categories of neurotoxic emergency: drug-induced and toxin-induced seizures, acute depressed mental status, acute excited mental status, and peripheral neurotoxic agents. Selected xenobiotics, representing the frontiers of neurotoxic emergencies, are discussed in detail based on the major neurotransmitters involved.
Subject(s)
Neurotoxicity Syndromes/etiology , Seizures/chemically induced , Emergencies , Humans , Neurotoxicity Syndromes/diagnosis , Neurotoxicity Syndromes/therapy , Seizures/diagnosis , Seizures/therapyABSTRACT
INTRODUCTION: Vasopressin is a novel vasopressor agent used for intractable hypotension. There is little published data available on its use in the poisoned patient. We performed a randomized, controlled, blinded trial in a porcine model to study the effects of vasopressin infusion on mean arterial pressure after verapamil poisoning. METHODS: Eighteen anesthetized monitored swine received a verapamil infusion of 1 mg/kg/hr until the mean arterial pressure (MAP) had decreased to 70% of baseline. At this time, a continuous infusion of either vasopressin (0.01 U/kg/min) or an equal volume of normal saline was initiated. The swine were monitored for 60 minutes after initiation of the study infusion. The primary outcome was MAP. RESULTS: There was no statistically significant difference between the two groups in MAP, cardiac output or systemic vascular resistance. One half (four of eight) of the animals in the vasopressin group died, compared with 20% (two of ten) of those in the saline group. CONCLUSIONS: Vasopressin infusion decreased the survival of verapamil-poisoned swine when compared to those treated with saline alone in this experimental model.
Subject(s)
Antidotes/therapeutic use , Poisoning/drug therapy , Vasoconstrictor Agents/therapeutic use , Vasodilator Agents/poisoning , Vasopressins/therapeutic use , Verapamil/poisoning , Animals , Antidotes/pharmacokinetics , Blood Pressure/drug effects , Blood Pressure/physiology , Cardiac Output/drug effects , Cardiac Output/physiology , Disease Models, Animal , Heart Rate/drug effects , Heart Rate/physiology , Longevity/drug effects , Male , Poisoning/metabolism , Single-Blind Method , Swine , Vasoconstrictor Agents/pharmacokinetics , Vasodilator Agents/pharmacokinetics , Vasopressins/pharmacokinetics , Verapamil/pharmacokineticsABSTRACT
Pediatric toxic ingestions are treated commonly by pediatricians and emergency physicians. Significant injury after these ingestions is infrequent, but identifying the dangerous ingestion is sometimes a difficult task. By performing a detailed history, focused physical examination, and directed laboratory evaluation, an estimation of risk can be developed. This article introduced the term "toxic triage" to describe this process. The toxic triage estimation allows the clinician to make thoughtful decontamination and treatment decisions. Familiarity with the literature supporting or refuting each decontamination method allows educated decisions to be made. Supportive care is an integral part of treatment for all poisonings, from asymptomatic to life-threatening. Most antidotes are used rarely in clinical practice, but familiarity with common antidotes benefits those patients with specific hazardous ingestions. Prevention efforts have the potential to decrease the incidence of pediatric poisonings. The universal poison control center number provided should be distributed and posted in homes, clinics, and emergency departments.
