Treatment of acetaminophen ingestion with a superactivated charcoal-cola mixture.

STUDY OBJECTIVE: We evaluate the adsorptive capacity of a superactivated charcoal-cola mixture to acetaminophen compared with superactivated charcoal alone. METHODS: This was a triple-arm, prospective, unblinded study of 8 healthy adult human volunteers who ingested 80 mg/kg of acetaminophen. In the control arm of the study, participants ingested acetaminophen alone. In the next arm, acetaminophen was followed by 1 g/kg of superactivated charcoal mixed with water. In the final arm, acetaminophen was followed by 1 g/kg of superactivated charcoal mixed with caffeine-free diet cola. Serum acetaminophen concentrations over 6 hours for each arm were analyzed for area under the time-concentration curve (AUC), peak concentrations, and time to peak concentrations. RESULTS: AUCs were 298.5+/-82.5 mg-h/L (control), 77.1+/-85.2 mg-h/L (superactivated charcoal), and 81.3 +/- 71.8 mg-h/L (superactivated charcoal-cola). Comparison of AUCs by analysis of variance revealed mean square of 128,315.1 between treatments, and residual mean square of 6,405.0, yielding an F ratio of 20.03 (P <.0001). Student-Newman-Keuls pairwise multiple comparison procedure revealed a statistically significant difference in AUC for control versus superactivated charcoal (P <.05) and for control versus superactivated charcoal-cola (P <.05), but not for superactivated charcoal versus superactivated charcoal-cola (P >.05). Time-concentration curves for the 3 study arms were illustrated graphically. CONCLUSION: Combining superactivated charcoal with cola does not limit the adsorptive capacity of superactivated charcoal.

Coma and respiratory depression following the ingestion of GHB and its precursors: three cases.

Gamma hydroxybutyrate (GHB) is a product of the metabolism of both gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD). Gamma hydroxybutyrate (GHB) is an illegal agent that causes central nervous system depression. Chemical precursors of GHB, such as GBL and 1,4-BD, have been available for purchase from many health food stores and Internet websites for mood-enhancement, sleep-induction, and stimulation of growth hormone release. We report three cases of ingestion of products containing GHB and chemical precursors of GHB. All three patients had severe presentations followed by full recoveries. Some products containing GBL were withdrawn from the market after the FDA issued a warning regarding these products. Products containing 1,4-butanediol remain on the market today.

Falsely elevated digoxin level of 45.9 ng/mL due to interference from human antimouse antibody.

CASE REPORT: We report the case of a 77-year-old man who was admitted to the intensive care unit with a serum digoxin level of 45.9 ng/mL. The patient was hemodynamically stable throughout his hospital course and did not require antidigoxin antibody fragments. The elevated digoxin level was determined by subsequent testing to be falsely elevated by interference from human antimouse antibodies in his serum. A repeat digoxin measurement using an assay not affected by human antimouse antibodies indicated a level of 1.3 ng/mL. Newer digoxin assays are not affected by human antimouse antibody interference, but clinicians should be aware of possible human antimouse antibody interference with older digoxin assays and in other tests utilizing mouse monoclonal antibody reagents.

One-year follow-up of technetium-99m-HMPAO SPECT in mild head injury.

UNLABELLED: We evaluated the predictive capacity of 99mTc-HMPAO SPECT for clinical outcome during a follow-up period of 12 mo after mild head injury. METHODS: We prospectively evaluated 136 patients with mild head injury who underwent initial SPECT imaging (SPECTO) within 4 wk after the trauma. Re-evaluations were made 2.9-3.3 mo (T3mo), 5.7-6.3 mo (T6mo) and 11.9-12.6 mo (T12mo) postinjury. All patients with an abnormal SPECT underwent a repeat study at the subsequent time of evaluation. Patients with a previously normal SPECT scan did not undergo a repeat study. Clinical reassessments (CLIN) were performed as long as the earlier study had been positive or until patients were completely asymptomatic. RESULTS: During all follow-up evaluations, SPECT had a high sensitivity and negative predictive value, increasing from 91% and 89%, respectively, at T3mo to 100% at T6mo and at T12mo. Clinical normalization occurred earlier than scintigraphic normalization. However, at 12 mo postinjury, we observed considerable improvement in the specificity and positive predictive value of SPECT (85% and 83%, respectively). The persistent lesions on the SPECT scan were related to their severity and to localization in the frontal cortex. CONCLUSION: A normal 99mTc-HMPAO SPECT scan is a reliable tool in the exclusion of clinical sequelae of mild head injury. At 12 mo postinjury, a positive SPECT study is also a reliable predictor for clinical outcome.

Prospective evaluation of technetium-99m-HMPAO SPECT in mild and moderate traumatic brain injury.

UNLABELLED: We prospectively evaluated the contribution of 99mTc-HMPAO SPECT in patients who have sustained acute, mild or moderate head trauma. METHODS: Forty-two patients formed the first subgroup of moderate trauma (ModTr) and 25 patients formed the second subgroup of mild trauma (MilTr). All 67 patients underwent an initial SPECT (Tinit) within 4 wk after a closed cranial trauma. After a mean interval of 3 mo from the time of Tinit, all patients were clinically re-evaluated; those with an abnormal Tinit underwent a repeat SPECT (Trpt) as well. All SPECT studies were visually graded by agreement of three observers adjudging a score ranging from 0 (no lesions) to 4. RESULTS: For the group as a whole (ModTr + MilTr), the following results could be derived: (1) in 32/33 Tinit negative cases, clinical symptoms had resolved; (2) the positive predictive value of Tinit was only 20/34 (59%); (3) the sensitivity for the repeat SPECT was 19/20 (95%). CONCLUSION: Our results show that: (1) SPECT alterations correlate well with the severity of the trauma; (2) a negative initial SPECT study is a reliable predictor of a favorable clinical outcome; (3) in cases with a positive initial SPECT, a follow-up consisting of a combination of SPECT and clinical data is necessary; (4) in patients suffering from postconclusive symptoms, SPECT offers an instrument to objective sequelae.

Regional cerebral blood flow in unipolar depression measured with Tc-99m-HMPAO single photon emission computed tomography: negative findings.

Recent studies have reported that patients with unipolar major depression may show a lower whole brain cerebral blood flow (CBF) and reduced regional CBF in frontal, temporal, and parietal lobes. The present study used single photon emission computed tomography (SPECT) with the CBF marker Tc-99m-hexamethylpropyleneamineoxine (HMPAO) to measure the cortical CBF of six individual regions of interest (ROIs), total ROI, and left or right hemispheric total ROI in 43 unipolar depressed subjects and 12 normal control subjects. There were no significant differences in the distribution of Tc-99m-HMPAO uptake into total ROI, right or left global ROI, prefrontal, motor frontal, parietal, temporal, visual cortex, or associative visual cortex between patients with melancholic depression, simple major depression, or minor depression and healthy control subjects. There were also no significant differences in the right-left distribution of uptake between the patients and the control subjects. Hypoperfusion was observed in motor frontal and parietal cortex of patients who had been taking benzodiazepines during the study period. It is concluded that cortical CBF, as assessed with Tc-99m-HMPAO SPECT, is relatively intact in the present sample of patients with severe depression.

99mTc-DMSA scintigraphy in acute urinary tract infection in children.

24 children with symptomatic urinary tract infection (UTI) underwent systematically ultrasound studies (US) and 99mTc-DMSA renal scans. Among the 15 patients considered as acute pyelonephritis (APN) on clinical grounds, the scan was abnormal in 12 cases, in contrast with only 1 abnormal scan in the clinical subgroup of the lower UTI. Among the 10 abnormal scans that were repeated later on, 6 did completely normalize. US showed only once a parenchymal appearance suggestive for APN. Our findings suggest that the DMSA scan has to be considered at present as the most sensitive imaging technique for the detection of APN.

Improved renal function during chronic lisinopril treatment in moderate to severe primary hypertension.

The effect of the converting enzyme inhibitor lisinopril on renal and cardiac hemodynamics was studied in patients with moderate to severe primary hypertension, in a multicenter, double-blind, randomized clinical trial comparing the antihypertensive effect of lisinopril (LIS) and nifedipine (NIF). After a 2 week placebo run-in period, 15 patients were randomized in a 2:1 ratio to receive either LIS (20-80 mg q.d., n = 10) or NIF (20-40 mg b.i.d., n = 5). LIS significantly reduced blood pressure (BP) without changing heart rate or cardiac output. LIS significantly increased renal blood flow; glomerular filtration rate (GFR) was not changed. It can be concluded that LIS is an effective antihypertensive agent with a favorable renal hemodynamic profile.

Effect of carvedilol on ambulatory blood pressure, renal hemodynamics, and cardiac function in essential hypertension.

A randomized, double-blind, placebo-controlled study was set up to study the effects of acute and chronic administration of carvedilol, a vasodilatory beta-blocker in essential hypertension. Acute administration of a single dose of 50 mg of carvedilol reduced systolic and diastolic blood pressure, without inducing reflex tachycardia. Renal blood flow was preserved; accordingly renal vascular resistance was significantly reduced. A significant reduction of glomerular filtration rate and filtration fraction was observed. Plasma renin activity (PRA) and plasma aldosterone were not changed. Chronic carvedilol treatment produced a significant fall in systolic and diastolic office and ambulatory blood pressure, heart rate, cardiac output, PRA and plasma aldosterone. Blood pressure variability was not changed. Renal blood flow, glomerular filtration rate and filtration fraction also remained unchanged; renal vascular resistance decreased significantly. It is concluded that carvedilol possesses definite antihypertensive and renal vasodilating properties, both acutely and after chronic treatment.