[Fatal ecstasy intoxication in a 22-year-old man]. / Ecstasy-intoxicatie met fatale afloop bij een 22-jarige man.

A 22-year-old man was admitted to the hospital with an ecstasy (MDMA) intoxication which was accompanied by hyperthermia. The patient developed rhabdomyolysis with hyperkalaemia, hypoglycaemia and acidosis, followed by multiple organ failure with disseminated intravascular coagulation and cerebral oedema. Despite maximal symptomatic treatment, the patient died after 4 days. MDMA is a serotonin agonist but also has noradrenergic and dopaminergic effects. It is a popular drug in the Netherlands among young people and is often wrongly considered to be safe. The occurrence of serious side effects is unpredictable and can have fatal consequences. Especially hyperthermia as a side effect of MDMA is a potentially life-threatening complication. The treatment is mainly symptomatic and consists of cooling, fluids, treatment of electrolyte disturbances, and support for respiration and circulation. The usefulness of dantrolene in the treatment of MDMA-induced hyperthermia is controversial, but for now it is still recommended.

[A fatal infection due to avian influenza-A (H7N7) virus and adjustment of the preventive measures]. / Een fatale infectie door aviair influenza-A (H7N7)-virus en aanpassing van het preventiebeleid.

In February 2003, the highly pathogenic avian influenza-A virus, subtype H7N7, was the causative agent of a large outbreak of fowl plague in the Netherlands. Two days after visiting a poultry farm that was infected by fowl plague, a 57-year-old male veterinarian developed malaise, headache and fever. After 8 days he was admitted to hospital with signs of pneumonia. Five days later, his condition deteriorated alarmingly. Despite extensive pharmacotherapy he died 4 days later of acute pneumonia. Influenza-A virus, subtype H7N7, was identified by means of reverse transcriptase/PCR in broncho-alveolar washings that had been obtained earlier; routine virus culture yielded the isolate A/Nederland/219/03, which differs by 14 amino-acid substitutions from the first isolate in a chicken (A/kip/Nederland/1/03). Partly as a result of this case, the preventive measures were then adjusted; people who came into contact with infected poultry were given increased possibilities for vaccination and the administration of oseltamivir.

[Fatal arrhythmia following administration of suxamethonium in a postpartum woman subsequently found to have dystrophia myotonica]. / Fatale hartritmestoornis na toediening van suxamethonium aan een kraamvrouw die achteraf dystrophia myotonica bleek te hebben.

A 28-year-old woman died of irreversible ventricular fibrillation after administration of succinylcholine because of post partum curettage. Afterwards it became known she had undiagnosed myotonic dystrophy. She also had metabolic acidosis because of haemorrhagic hypovolaemia resulting in a probably elevated serum K+ concentration preoperatively. Succinylcholine given to patients with myotonic dystrophy may lead to life threatening hyperkalaemia and cardiac arrest. Therapy should be aimed at immediate lowering of serum K+ concentration with calcium, sodium bicarbonate and hyperventilation.

Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil.

The magnitude and duration of analgesia and respiratory depression induced by fentanyl (1.0, 2.0, and 4.0 micrograms/kg) and sufentanil (0.1, 0.2, and 0.4 microgram/kg) after intravenous administration over 30 s were measured in 30 healthy young adult male volunteers divided into three groups and studied in a double-blind, randomized fashion. Each volunteer received one dose of fentanyl or sufentanil and no sooner than 48 h later, the corresponding equipotent dose of the other opioid. End-tidal CO2 and ventilatory and occlusion pressure responses to CO2 rebreathing were used to measure drug-induced respiratory effects. Analgesic effects were assessed by changes in the pain threshold to electric shock applied to the forearm. Plasma levels of fentanyl and sufentanil were measured by radioimmunoassay. Testing and sampling intervals were 5, 30, 60, 90, 120, 240, 300, and 360 min after drug administration. The magnitude and duration of depression of the ventilatory and occlusion pressure response were significantly less with sufentanil compared with fentanyl, irrespective of dose. Ventilatory and occlusion pressure responses returned to control values by 30 and 30 min, respectively, after sufentanil and by 240 and 120 min, respectively, after fentanyl. Statistically significant elevations of the pain threshold were, however, greater and longer lasting after sufentanil compared with fentanyl. Pain threshold returned to control values 180 min after sufentanil but only 90 min after fentanyl. These results suggest that sufentanil may provide better patient comfort with less respiratory depression than does fentanyl.