A Case Report on Varenicline Induced Delirium in an Alcohol and Nicotine Dependent Patient.

Varenicline is a smoking cessation agent. Varenicline acts as a partial agonist of α4ß2 neuronal nicotinic acetylcholine receptor and prevents nicotine binding to the same. It also causes dopamine (DA) stimulation that decreases craving and symptoms of dependence. A 40-year-old male diagnosed with alcohol and nicotine dependence syndrome was treated with 1 mg of varenicline for 3 days. Patient developed episodes of transient delirium within 15-30 min after administration of varenicline. Patient was disoriented and did not respond relevantly. Patient would have disorientation and would respond irrelevantly and was unable to recall the event completely. There were no features suggestive of seizures. The episodes resolved after the medication was stopped. Varenicline, with its partial agonistic effect on nicotinergic receptors, stimulates the release of multiple neurotransmitters including DA. DA dysregulation is probably responsible for the development of neuropsychiatric adverse reactions due to varenicline. This is the first case report to the best of our knowledge reporting varenicline induced dilirium. In this case, the adverse event was found in an alcohol and nicotine dependent patient undergoing treatment. It is essential to monitor uncommon adverse effects as this can cause significant morbidity.

Postmortem vitreous chemistry--an evaluation of sodium, potassium and chloride levels in estimation of time since death (during the first 36 h after death).

Estimation of time since death is a paramount medico-legal issue in any postmortem examination. The present study is intended to study the correlation between postmortem interval and vitreous humor chemistry for sodium, potassium, and chlorides. The study is aimed to find male-female differences and differences between right and left eyes in vitreous chemistry. The vitreous humor samples were collected in 114 autopsies conducted in the study center and analyzed biochemically. All the cases where exact time of death was known and where the time since death ranged between 0 and 36 h were included in the study. Data obtained was analyzed statistically using spss version 11.0. The present research did not find a significant correlation between vitreous chemistry and postmortem interval. The differences in vitreous sodium, potassium, chloride levels and the sodium potassium ratio among males and females and between right and left eyes were not found to be statistically significant.