ABSTRACT
The purpose of this study is to show a very rare complication of acute cocaine poisoning, namely heart rupture. In the present case report, acute cocaine intoxication caused massive myocardial infarction, resulting in heart rupture and cardiac tamponade. A crime scene investigation found a dead body on the street in a drug dealing district. Examination of the body showed no external injuries. A thorough autopsy was performed showing massive cardiac tamponade with 510 ml of blood within the pericardium and full-thickness tissue lesion at the posterior wall of the left ventricle of 3.5 × 3 cm. Histological examination in hematoxylin and eosin was performed and confirmed the interruption of the posterior wall of the left ventricle with the presence of blood. In fact, although the correlation between cocaine and myocardial damage is well established, the relationship between heart rupture and acute cocaine intoxication is an extremely rare event. Moreover, since there are, to date, few reports of similar deaths, our report provides useful information regarding sudden death in a cocaine abuser. It is, therefore, of crucial importance to report this case to the scientific community.
Subject(s)
Cocaine/poisoning , Heart Rupture , Myocardial Infarction , Vasoconstrictor Agents , Autopsy , Cocaine-Related Disorders , Death, Sudden , Forensic Toxicology , Heart Rupture/chemically induced , Humans , Male , Middle Aged , Myocardial Infarction/chemically induced , Vasoconstrictor Agents/poisoningABSTRACT
Vasoactive agents should be administered through a controlled well-marked infusor pump, ideally via a central venous catheter if given over longer periods of time. During transfer of haemodynamically unstable patients with limited staffing and resources on site, a peripheral vasopressor infusion is sometimes resorted to as a temporary measure of optimising haemodynamic parameters. We report a case of accidental norepinephrine overdose after such practice, resulting in cardiac arrest. It illustrates the importance of careful use and labelling of vasoactive agents during the transport and handover of critically ill patients. Finally, we explore human factor issues associated with transfer from the pre-hospital to the in-hospital environment when such preparations are used.
Subject(s)
Drug Overdose/physiopathology , Heart Arrest/chemically induced , Norepinephrine/poisoning , Vasoconstrictor Agents/poisoning , Critical Illness , Crystalloid Solutions/administration & dosage , Hemodynamics , Humans , Male , Medication Errors , Middle AgedABSTRACT
Takotsubo cardiomyopathy (TTC) is characterized by reversible ventricular dysfunction induced by endogenous and, occasionally, exogenous catecholamine. We present a report on a patient who developed TTC and cardiogenic shock during percutaneous coronary intervention (PCI) secondary to inadvertent norepinephrine administration. His hemodynamic status and cardiac function were totally restored within 1 week after hemodynamic support using intra-aortic balloon pump without sequela. Thus, TTC should be considered once a patient presents with symptoms mimicking acute coronary syndrome (ACS) after catecholamine administration.
Subject(s)
Coronary Restenosis/surgery , Hypotension/drug therapy , Intraoperative Complications/drug therapy , Medication Errors , Norepinephrine/poisoning , Percutaneous Coronary Intervention , Shock, Cardiogenic/chemically induced , Takotsubo Cardiomyopathy/chemically induced , Vasoconstrictor Agents/poisoning , Adrenergic beta-1 Receptor Antagonists/therapeutic use , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Bisoprolol/therapeutic use , Creatine Kinase/blood , Creatine Kinase, MB Form/blood , Drug Overdose , Drug-Eluting Stents , Echocardiography , Humans , Iatrogenic Disease , Intra-Aortic Balloon Pumping , Male , Middle Aged , Recovery of Function , Shock, Cardiogenic/blood , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/therapy , Stents , Stroke Volume , Takotsubo Cardiomyopathy/blood , Takotsubo Cardiomyopathy/diagnostic imaging , Takotsubo Cardiomyopathy/therapy , Troponin I/blood , Valsartan/therapeutic useABSTRACT
ABSTRACT Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) Main Etiologic (testicular torsion) Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.
Subject(s)
Humans , Male , Adult , Scrotum/blood supply , Testicular Diseases/etiology , Testis/blood supply , Cocaine-Related Disorders/complications , Acute Pain/etiology , Ischemia/etiology , Scrotum/pathology , Spermatic Cord Torsion/pathology , Testicular Diseases/pathology , Testis/pathology , Vasoconstrictor Agents/poisoning , Cocaine/poisoning , Diagnosis, Differential , Ischemia/pathologyABSTRACT
Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) ⢠Main Etiologic (testicular torsion) ⢠Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.
Subject(s)
Acute Pain/etiology , Cocaine-Related Disorders/complications , Ischemia/etiology , Scrotum/blood supply , Testicular Diseases/etiology , Testis/blood supply , Adult , Cocaine/poisoning , Diagnosis, Differential , Humans , Ischemia/pathology , Male , Scrotum/pathology , Spermatic Cord Torsion/pathology , Testicular Diseases/pathology , Testis/pathology , Vasoconstrictor Agents/poisoningABSTRACT
Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Ergotamine/poisoning , Ergotism/etiology , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Peripheral Arterial Disease/chemically induced , Ritonavir/adverse effects , Drug Interactions , Drug Therapy, Combination/adverse effects , Vasoconstrictor Agents/poisoningSubject(s)
Amlodipine/poisoning , Chlorothiazide/poisoning , Intensive Care Units , Necrosis/chemically induced , Tongue/pathology , Vasoconstrictor Agents/poisoning , Antihypertensive Agents/poisoning , Diuretics/poisoning , Fluid Therapy , Humans , Male , Middle Aged , Necrosis/pathology , Suicide, AttemptedABSTRACT
Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.
Subject(s)
Ergotamine/poisoning , Ergotism/etiology , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Peripheral Arterial Disease/chemically induced , Ritonavir/adverse effects , Adult , Drug Interactions , Drug Therapy, Combination/adverse effects , Female , Humans , Male , Middle Aged , Vasoconstrictor Agents/poisoningABSTRACT
INTRODUCTION: Cocaine body packing, the internal concealment of cocaine for transportation between countries, may expose to life-threatening intoxications. No data is currently available on the pharmacokinetics of cocaine and its metabolites when a packet rupture occurs in a body packer. CASE REPORT: We report the first pharmacokinetic data associated with a severe cocaine intoxication in a body packer, resulting in cardiac arrest. Massive concentrations of cocaine (observed maximal concentration: 1.66 mg/L, 1 hour after the cardiac arrest) were measured in plasma up to about 15 hours, suggesting a prolonged absorption due to a slow-release in the gastrointestinal tract despite surgical extraction of the packets. Apparent cocaine elimination half-life was 7.6 hours. CONCLUSION: A prolonged apparent cocaine elimination half-life has been observed. Further pharmacokinetic studies are needed to understand better the pathophysiology of acute cocaine intoxication in body packers.
Subject(s)
Cocaine-Related Disorders/blood , Cocaine/pharmacokinetics , Heart Arrest/chemically induced , Vasoconstrictor Agents/pharmacokinetics , Cocaine/poisoning , Crime , Drug Overdose , Half-Life , Heart Arrest/blood , Humans , Male , Middle Aged , Vasoconstrictor Agents/poisoningSubject(s)
Cardiovascular Diseases/chemically induced , Ergotamine/poisoning , Vasoconstrictor Agents/poisoning , Cardiovascular Diseases/physiopathology , Crystallography, X-Ray , Ergotamine/chemistry , Ergotamine/therapeutic use , Ergotism/diagnosis , Ergotism/physiopathology , Humans , Migraine Disorders/drug therapy , Vasoconstrictor Agents/chemistry , Vasoconstrictor Agents/therapeutic useABSTRACT
The report presents a rare case of homicide. A mummified body of a man was found bricked up in the kitchen. Toxicological examination revealed high concentration levels of ergotamine in the internal organs and blood.
Subject(s)
Ergotamine/poisoning , Homicide , Vasoconstrictor Agents/poisoning , Autopsy , Cause of Death , Crime Victims , Drug Overdose , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
The Food and Drug Administration has banned the sale of ephedrine-based weight-loss products because of their association with many cardiovascular adverse effects. Bitter orange is now being used as a stimulant in "ephedra-free" weight-loss supplements but was recently implicated in adverse cardiovascular sequelae. To our knowledge, this report describes the first case of variant angina associated with bitter orange in a dietary supplement.
Subject(s)
Angina Pectoris, Variant/chemically induced , Dietary Supplements/poisoning , Synephrine/poisoning , Vasoconstrictor Agents/poisoning , Angina Pectoris, Variant/diagnosis , Diagnosis, Differential , Electrocardiography , Humans , Male , Middle AgedSubject(s)
Factitious Disorders , Adult , Epinephrine/poisoning , Factitious Disorders/complications , Factitious Disorders/diagnosis , Fatal Outcome , Female , Humans , Jurisprudence , Male , Middle Aged , Myocardial Ischemia/chemically induced , Pneumonia, Aspiration/complications , Sepsis/complications , Sick Role , Vasoconstrictor Agents/poisoningABSTRACT
Cranial multineuropathy is an uncommon occurrence. We observed two cases of multinevritis of the cranial nerves which had many features in common: acute onset after toxic inhalation, occurrence of neuroparaxic block, and rapid resolution after corticosteroid therapy. We believe physicians should be aware that multinevritis of the cranial nerves may be related to acute exposure to toxic substances. Missing this diagnosis could lead to a delay in therapy.