Overdose with levetiracetam: a case report and review of the literature.

WHAT IS KNOWN AND OBJECTIVE: Levetiracetam is an anticonvulsant agent that was first approved for use in the United States in 1999 and has a maximum recommended adult dose of 3000 mg daily. It has been noted to have a relatively mild adverse effect profile, with the most common side effects being somnolence, asthenia, infection, and dizziness. Although it has been widely prescribed, there have been few reports on the safety of this agent in overdose. CASE SUMMARY: We present the case of a 49-year-old man who ingested over 22 500 mg of levetiracetam in a suicide attempt. The patient arrived at the Emergency Department 6·5 h after the ingestion and was noted to have no significant sequelae from the ingestion. Based on the patient's weight, he ingested 358 mg/kg of levetiracetam. WHAT IS NEW AND CONCLUSION: The few cases of levetiracetam overdose reported in the literature were associated with relatively mild, if any, symptoms. However, one patient who overdosed on levetiracetam became obtunded and developed significant respiratory distress that required intubation and ventilatory support. Therefore, clinical vigilance is still required in the cases of levetiracetam overdose.

Pain management in the special operations environment: regional anesthetics.

Pain relief is an essential component of combat casualty care. For the injured soldier, analgesia is not only a matter of comfort. Alleviating pain may allow the soldier to remain quiet when noise discipline is at a premium. It may also allow that person to continue to move, thus avoiding detection and potentially permitting the mission to carry on. Regional anesthetics provide an alternative to systemic medications and thus may avoid a clouded sensorium, limit narcotic administration, and provide superior pain relief. Standard local anesthetics and newer agents with potential field applicability are discussed along with their side effect profiles. Simple nerve block techniques that can be used by Army Special Forces medics, Navy SEAL and Reconnaissance corpsmen, and Air Force pararescuemen in the far forward environment are described step by step. The advantages of these regional anesthetic methods should make their use a must for every special operations medical care provider.