Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia.

Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery.

Glasgow coma scale and its components on admission: are they valuable prognostic tools in acute mixed drug poisoning?

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning.

Fatality in paraquat poisoning.

INTRODUCTION: Acute paraquat (PQ) poisoning continues to be a major public health concern in many developing countries. This study was designed to evaluate the data on cases of acute PQ poisoning and compare the different variables between survivors and non-survivors. METHODS: All patients of PQ poisoning who were admitted to the poisoning emergency department during the past five years were retrospectively evaluated. The different variables that were compared between survivors and non-survivors included age and gender, the time from ingestion of PQ to hospital admission, the amount of PQ ingested, occurrence of vomiting after ingestion, the time from hospital admission to initiation of haemodialysis, the length of hospital stay and the outcomes. RESULTS: A total of 29 patients were evaluated. The in-hospital fatality rate was 55.2 percent. No significant differences were observed between survivors and non-survivors with regard to the patient characteristics. Most of the patients who died had ingested more than 40 mg/kg of 20 percent PQ (62.5 percent). There was a correlation between the outcome of patients and vomiting (p-value is 0.05; correlation coefficient is 0.45) and age (p-value is 0.013; correlation coefficient is 0.56). CONCLUSION: A large amount of ingested PQ, vomiting and age may be important variables to consider in association with the high fatality rate of PQ poisoning.

Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores.

The aim of this study was to evaluate the scores of the Acute Physiology and Chronic Health Evaluation (APACHE) II and a modified APACHE II system (MAS), without parameters of biochemical tests; and to find prognostic value of individual elements of the APACHE II and MAS in predicting outcomes in organophosphate (OP) poisoning. Data were collected from 131 patients. The median (25th-75th percentiles) of APACHE II score for survivors without intubation were found to be lower than those of non survivors or survivors with intubation and ventilation, [4 (1-7); versus 17.5 (7.8-29), and 13.5 (7.8-16.3)]. Logistic regression analysis identified white blood cell (WBC), potassium, Glasgow coma scale (GCS), age and sodium in APACHE II; GCS and mean arterial pressure in MAS system as prognostically valuable. There was no statistically significance difference between APACHE II and MAS scores in terms of area under Receiver Operating Characteristic Curve [(0.902, 95% confidence interval: (0.837-0.947) for APACHE II), and (0.892, 95% confidence interval: (0.826-0.940) for MAS); P=0.74) to predict need for intubation. It is concluded usage of MAS facilitates the prognostication of the OP poisoned patients due to simplicity, less time-consuming and effectiveness in an emergency situation.