ABSTRACT
A 55-year-old man was admitted after a suspected hypnotic overdose of valerian extracts. In addition to altered consciousness, the first clinical symptoms included not only diffuse rash on the face, trunk, and limbs, but also an inspiratory dyspnea with a marked hypoxemia. A major laryngeal edema was noted during orotracheal intubation. After correction of hypoxemia, the patient became agitated and propofol was administered by continuous infusion. In addition, the patient passed pink urine staining the urine collection bag. The presence of an unidentified toxic substance was suspected.
Subject(s)
Valerian/poisoning , Alcoholism/pathology , Crystallization , Ethanol/blood , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Pentanoic Acids/urine , Promethazine/blood , Promethazine/therapeutic use , Promethazine/urine , Tablets/administration & dosage , Tablets/poisoning , Uric Acid/urineABSTRACT
OBJECTIVE: Although extended-release (XR) formulations are recognized to bear some risk of pharmacobezoar formation in overdose, there are no previously documented reports of this phenomenon with quetiapine. We describe nine cases of pharmacobezoar formation in acute quetiapine XR overdose. METHODS: Observational case series of all patients who underwent gastroscopy after quetiapine XR overdose, which were reported by physicians to the Swiss Toxicological Information Centre between January 2010 and December 2012, with detailed analysis of cases with documented pharmacobezoar. RESULTS: Gastric pharmacobezoars were detected in 9 out of 19 gastroscopic evaluations performed during the study period. All these patients ingested a large dose of quetiapine XR (10-61 tablets; 6-24.4 g quetiapine). All patients but one also coingested at least one other substance, and in three cases another XR drug formulation. Gastroscopic pharmacobezoar removal was achieved without complications in all patients, but was difficult due to the particular "gelatinous-sticky-pasty" consistency of the concretion. The subsequent clinical course was favorable. CONCLUSIONS: The possibility of pharmacobezoar formation following a large quetiapine XR overdose should be considered, as this may influence acute patient management. Complete endoscopic pharmacobezoar removal may be a promising approach in selected cases, but further studies are needed to define its role.
Subject(s)
Antipsychotic Agents/poisoning , Bezoars , Delayed-Action Preparations/poisoning , Dibenzothiazepines/poisoning , Drug Overdose/therapy , Stomach/drug effects , Adult , Chemistry, Pharmaceutical , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Quetiapine Fumarate , Tablets/poisoning , Young AdultSubject(s)
Poisoning/diagnostic imaging , Stomach/diagnostic imaging , Tablets/pharmacokinetics , Cadaver , Female , Gastric Emptying/physiology , Gastric Lavage , Humans , Male , Poisoning/etiology , Poisoning/therapy , Retrospective Studies , Stomach/anatomy & histology , Stomach/physiology , Tablets/poisoning , Ultrasonography , Young AdultABSTRACT
An asymptomatic 18 month old child presents to the emergency department of a small district hospital shortly after ingesting two unidentified tablets. A small number of pharmaceuticals and illicit drugs may produce life threatening toxicity in a small child if ingested even in one or two dose units and the onset of toxicity may be delayed for some agents. Following risk assessment, a rational management plan is devised and the child is carefully monitored. The patient is observed overnight and discharged home the following day.
Subject(s)
Emergency Medical Services/methods , Poisoning/diagnosis , Tablets/poisoning , Decontamination , Eating , Female , Humans , Infant , Monitoring, Physiologic/methods , Risk Assessment/methodsABSTRACT
No disponible
