Suspected central nervous system toxicity from inadvertent nonsteroidal antiinflammatory drug overdose.

This case illustrates a severe adverse reaction of the central nervous system involving a moderate overdose of diclofenac sodium along with therapeutic dosages of indomethacin and ibuprofen. Our patient became disoriented, hallucinated, lost consciousness, and suffered respiratory arrest after ingesting five diclofenac tablets (375 mg total), two ibuprofen tablets (400 mg total), and one indomethacin capsule (75 mg). Aggressive supportive therapy was instituted and the patient improved. She was awake, alert, and extubated in less than 24 hours with no serious sequelae.

Selected cardiac and metabolic responses to pseudoephedrine with exercise.

Pseudoephedrine hydrochloride was evaluated at two dosage levels in six normal healthy males, at rest and during submaximal exercise. Although there appeared to be a dose-related rise and during submaximal exercise. Although there appeared to be a dose-related rise in resting heart rate, it was not statistically significant. The drug had no effect on the amount of time required to reach 85 per cent maximal predicted heart rates while on the treadmill or on the amount of time required to recover baseline heart rates. Also, there was no drug effect observed on blood pressure at rest, during exercise, or in the recovery period. There was a significant increase in the frequency of sinus arrhythmias after the 120-mg pseudoephedrine dose. There appeared to be no drug effect on postexercise blood glucose and insulin levels.

Combined effects of fenmetozole and ethanol.

Eight male subjects took none or 200 mg fenmetozole 1 hr before drinking a beverage containing none or 50 ml/70 kg ethanol. Tests designed to measure mental and motor performance were administered 2 hr after fenmetozole ingestion. Fenmetozole alone impaired standing steadiness but improved mental performance in one test. Fenmetozole did not antagonize the decrement in performance induced by this amount of ethanol. In combination, the subjective symptoms caused by fenmetozole were additive with those of ethanol.

Smoking and allergic history as correlative risk factors in pulmonary function performance.

Pulmonary function data were compared with smoking history and past personal and family history of asthma, hay fever and eczema in apparently healthy males age 30 to 39. Mean values for FEV1 and MMEF were significantly lower in smokers with a positive allergic history compared to non-allergic smokers.

Impaired water handling in chronic obstructive lung disease.

Impaired water excretion has been described in stable, nonedematous patients with chronic obstructive lung disease (COLD). To elucidate the mechanism involved, we measured basal glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and water, sodium, and solute excretion for 4 hours after water loading (20 ml. per kilogram orally or as D5W intravenously) in two groups of 10 age-matched, hypoxic, stable, nonedematous COLD normocapneic and hypercapneic patients (PCO2 less than or greater than 45 mm. Hg, respectively). In 5 patients of each group, additional measurements of plasma and urine osmolality and plasma vasopressin were made at 30-minute intervals after oral water loading and the results compared to those obtained in 10 normal control subjects. Hypoxic (PO2 61 plus or minus 2 mm. Hg), normocapneic (PCO2 39 plus or minus 1 mm. Hg) patients had normal GFR (114 plus or minus 5 ml. per minute) and ERPF (517 plus or minus 31 ml. per minute) and excreted the load normally (101 plus or minus 5 per cent of oral or intravenous water per 4-hours). This was associated with a normal rate of sodium excretion (34 plus or minus 5 mEq. per 4-hours) and low-normal plasma vasopressin (1.9 plus or minus 0.7 pg. per milliliter) which was suppressed appropriately with water loading. Hypercapneic (PCO2' 62 plus or minus 5), hypoxic (PCO2' 57 plus or minus 2) patients had normal GFR (106 plus or minus 7), low baseline vasopressin (1.1 plus or minus 0.2) which was suppressed appropriately, and decreased (p less than 0.05) 4-hour water excretion (63 plus or minus 8 per cent), 4-hour sodium excretion (15 plus or minus 9), and ERPF (394 plus or minus 31). A significant correlation was observed between impaired water and impaired sodium excretion (p less than 0.05). These studies indicate that in COLD patients: (1) hypercapnia but not hypoxemia is related to the abnormal water handling and to the increased reabsorption of sodium by the renal tubule; (2) the defect in water excretion is not related to abnormal vasopressin secretion or metabolism; (3) the alteration in sodium excretion may be due to hypercapneic-induced increase in renal bicarbonate reabsorption and/or abnormal renal blood flow.