Carbon monoxide poisoning: undetected by both patients and their doctors.

Carbon monoxide poisoning represents a potentially preventable and reversible cause of mortality and morbidity if sources and cases can be identified. The elderly have been shown to be particularly at risk. Concerns continue to be raised about potential unrecognised cases of carbon monoxide poisoning. These concerns arise from difficulties in knowing who to suspect as a potential victim of poisoning as well as how, when and what to test. In general carbon monoxide has no helpful unique clinical presentation and is known to mimic common illnesses as well as exacerbate established diseases. As a gas it is undetectable by the human senses and is potentially present in most households. This paper reviews the issues associated with carbon monoxide poisoning including pointers to early diagnosis and discussion of pathophysiology and management.

Citalopram-induced severe hyponatraemia with coma and seizure. Case report with literature and spontaneous reports review.

Numerous case reports of hyponatraemia followed increasing use of selective serotonin re-uptake inhibitors (SSRIs) but this adverse effect was only rarely observed in relation to citalopram. We report a case of severe hyponatraemia associated with deep coma, seizure, atrial fibrillation and muscle damage in a 92-year-old woman after only two doses of citalopram, and review 14 cases previously published in the literature and 28 cases spontaneously reported to Australian Drug Reaction Advisory Committee (ADRAC). The data presented suggest that citalopram, as well as SSRIs may cause hyponatraemia secondary to syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The majority of symptomatic cases occurred in elderly patients (79% were older than 70 years) and in women (74%). Polymedication and concomitant use of another psychotropic drug or thiazide diuretic may precipitate and/or augment the development of hyponatraemia/SIADH. In 84% of cases, the hyponatraemia associated with citalopram was detected during the first month of treatment. High level of suspicion, close and careful monitoring of serum sodium concentration particularly in elderly patients and especially in the first month of therapy with citalopram may reduce the incidence of this serious and likely not rare adverse effect.

Entacapone-induced hepatotoxicity and hepatic dysfunction.

We describe 2 patients with Parkinson's disease who developed hepatotoxicity associated with the use of entacapone, a novel, mainly peripheral acting inhibitor of catechol-D-methyltransferase. Hepatotoxicity resolved rapidly with discontinuation of the drug. Analysis of causality in a further case initially linked to entacapone exposure was confounded by conflicting serial adverse reaction reports.