ABSTRACT
BACKGROUND: The main adverse effect of polymyxin B is nephrotoxicity. There are few data on polymyxin-associated renal injury. OBJECTIVE: To assess the prevalence of and risk factors for acute kidney injury (AKI) in patients treated with polymyxin B. METHODS: The studied population included 114 patients who received at least 3 consecutive days of intravenous polymyxin B and had baseline serum creatinine (SCr) and at least one further SCr measurement during treatment. AKI was defined as an SCr increase to 1.8 mg/dL or greater in patients with baseline SCr less than 1.5 mg/dL, or an increase greater than or equal to 50% in baseline SCr when it was already greater than or equal to 1.5 mg/dL, or need for dialysis. RESULTS: AKI developed in 22% of the patients. They were older, had a higher baseline SCr, had a higher frequency of baseline SCr greater than or equal to 1.5 mg/dL, used other nephrotoxic drugs and furosemide more often, and required vasoactive drugs and mechanical ventilation more frequently. Progression to renal failure was significantly more probable when the bacteria were isolated in the abdomen, catheter, or blood. AKI patients had a higher mortality rate (92% vs 53%; p < 0.001). Logistic regression identified abnormal baseline SCr (odds ratio [OR] 3.51); need for vasoactive drugs (OR 3.03); and abdomen, blood, or catheter as the infection site (OR 3.82) as independent risk factors for AKI. CONCLUSIONS: Patients who developed AKI had a strikingly elevated mortality rate. Polymyxin B should be used with extreme caution in patients who have an abnormal baseline SCr; use vasoactive drugs; or have abdomen, blood, or catheter as the infection site.
Subject(s)
Anti-Bacterial Agents/adverse effects , Kidney Diseases/chemically induced , Polymyxin B/adverse effects , Acute Disease , Acute Kidney Injury/chemically induced , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Bacterial Infections/physiopathology , Creatinine/blood , Disease Progression , Female , Humans , Infusions, Intravenous , Kidney Diseases/etiology , Kidney Diseases/mortality , Logistic Models , Male , Middle Aged , Polymyxin B/therapeutic use , Prevalence , Respiration, Artificial/adverse effects , Retrospective Studies , Risk Factors , Vasoconstrictor Agents/adverse effects , Vasoconstrictor Agents/therapeutic use , Young AdultABSTRACT
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 dosistema 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.
Subject(s)
Male , Female , Child , Adult , Aged , Humans , Antidepressive Agents, Tricyclic/toxicity , Drug Evaluation/adverse effects , Central Nervous System DepressantsABSTRACT
Three members of the same family ingested vegetables treated with aldicarb. All three developed signs and symptoms of acetylcholinesterase inhibition and all recovered a few hours after the ingestion. Reports of toxicity from the ingestion of aldicarb-contaminated food are uncommon. Aldicarb is a potent pesticide which can only be used safely if governmental and industry regulations are followed carefully.
Subject(s)
Aldicarb/poisoning , Brassica , Food Contamination , Insecticides/poisoning , Pesticide Residues/poisoning , Adult , Atropine/therapeutic use , Brazil , Cholinesterases/blood , Cholinesterases/metabolism , Female , Humans , Male , Middle Aged , Muscarinic Antagonists/therapeutic use , Poisoning/drug therapy , Poisoning/metabolism , Poisoning/pathologyABSTRACT
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
