Trastornos electrolíticos inducidos por fármacos y sustancias tóxicas / Electrolyte disorders induced by drugs and toxic substances

Las enfermedades pueden generar un desequilibrio de electrolitos como parte de su fisiopatología, al igual que los medicamentos usados crónicamente y algunas sustancias tóxicas disponibles en nuestro medio. A pesar de todos los datos estadísticos existentes, la incidencia global de los trastornos electrolíticos secundarios a fármacos o sustancias tóxicas permanece desconocida, y, posiblemente, subregistrada; por lo tanto, el objetivo de esta revisión es analizar los trastornos electrolíticos que causan algunos medicamentos y sustancias tóxicas, y describir el mecanismo a través del cual se producen las alteraciones, en particular, del sodio, potasio, magnesio, calcio y fósforo, con el fin de alertar a los profesionales de la salud en el momento de enfrentarse a este tipo de condiciones en su práctica clínica. El conocimiento de los efectos adversos relacionados con medicamentos y tóxicos es importante para prevenir, identificar y gestionar de forma eficaz, complicaciones que son potencialmente peligrosas. Esta revisión pretende ser un referente de apoyo para los profesionales de la salud en estas situaciones

Diseases can generate an electrolyte imbalance as part of their pathophysiology, as well as chronic use of some medications, and toxic substances available in our environment. Despite all the separate statistical data, the overall incidence of fluid and electrolyte disorders secondary to drugs or toxic substances remains unknown, and possibly underreported; therefore, the objective of this review is to analyze electrolyte disorders caused by some medications and toxic substances, and describe the mechanism through which changes in sodium, potassium, magnesium, calcium and phosphorus occur, in particular, in order to alert health professionals when facing this type of conditions in their clinical practice. Knowledge of drug and toxic-related adverse effects is important to effectively prevent, identify, and manage complications that can be potentially life-threatening. This review intends to be a reference for supporting health professionals in these situations

Use of low-molecular-weight heparin in severe paraquat poisoning: a case report.

BACKGROUND: Acute paraquat ingestion remains a leading cause of mortality in developing countries. There is currently no evidence that treatment with high-dose immunosuppressants and antioxidants improves survival in patients with paraquat poisoning, and better options are urgently needed. Here, we describe the unexpected survival and recovery of a patient with a potentially fatal paraquat poisoning. CASE PRESENTATION: After ingesting 28 mL of paraquat (20% ion w/v), confirmed by a deep blue color in the urine dithionite test (UDT), a 17-year-old Hispanic Colombian boy was treated according to the hospital protocol with cyclophosphamide, methylprednisolone, N-acetylcysteine, vitamin E and propranolol. Gastrointestinal endoscopy showed extensive ulceration and necrosis. As a novelty, enoxaparin at a single dose of 60 mg was added to his treatment. Despite the evidence of severe mucosal burns in the gastrointestinal tract and high paraquat concentrations found in the UDT, the clinical condition began to improve after 1 day of treatment, with full recovery and discharge from hospital after 21 days. CONCLUSIONS: Although the amount of paraquat ingested by the patient was large and the UDT indicated severe poisoning with a somber prognosis, unexpected survival of the patient was observed, and the addition of enoxaparin was the only change from the standard treatment.

Toxicity induced by multiple high doses of vitamin B12 during pernicious anemia treatment: a case report.

Context: The clinical consequences of excess vitamin B12 induced by multiple oral doses of cyanocobalamin are not well-known.Case details: A young woman was treated with multiple daily doses of 1 mg of cyanocobalamin for severe pernicious anemia. After a total dose of 12 mg, she developed acne, palpitations, anxiety, akathisia, facial ruddiness, headache, and insomnia. She improved two weeks after stopping the drug. There were no sequelae nor complications.Discussion: Although these symptoms of cobalamin toxicity were unexpected and unusual, the case reminds us that the administration of any drug is not entirely safe.

Epidemiología de los envenenamientos por animales acuáticos reportados a un centro de control toxicológico colombiano / Epidemiology of aquatic animal poisonings reported to a Colombian toxicology control center

RESUMEN Objetivo Caracterizar los casos de envenenamiento por animales marinos y dulceacuícolas atendidos por el CCT de la Universidad de Antioquia, Colombia, entre 2016 y 2018. Metodología Estudio observacional, retrospectivo, realizado a partir de la base de datos del CCT, que contiene las características demográficas y clínicas reportadas durante el manejo médico de cada emergencia toxicológica asesorada. El periodo analizado fue desde el 1 de enero del 2016 al 31 de diciembre de 2018. Los casos identificados como envenenamiento por animales acuáticos tuvieron seguimiento telefónico para saber si hubo complicaciones o secuelas. Resultados En el periodo se reportaron doce casos, once de ellos ocasionados por rayas dulceacuícolas. Siete de los afectados fueron hombres. La mediana de edad fue 30 años (rango: 8 a 44). En Antioquia y Caquetá se registraron 58% de los accidentes reportados. Aunque el uso empírico de antibióticos se dio en la mayoría de los casos, solo en cuatro de ellos se documentaron complicaciones infecciosas de piel y tejidos blandos, por lo cual requirieron tratamiento intrahospitalario. Conclusión El envenenamiento por animales de agua dulce y salada se presenta en Colombia. Aunque fueron pocos los casos en 3 años, el bajo registro nacional puede ser importante, pues amerita mayor preparación del personal médico y más investigación en este tema.(AU)

ABSTRACT Objective To characterize the cases of poisoning by marine and freshwater animals treated by the PCC of the University of Antioquia, Colombia, between 2016 and 2018. Methodology An observational, retrospective study using the PCC database that contains the demographic and clinical characteristics reported during the medical management during a toxicological emergency. Period analyzed was from January 1st, 2016 to December 31st, 2018. The cases identified as poisoning by aquatic animals had telephone follow-up to understand if there were complications or sequelae. Results Twelve cases were reported in the period, eleven of them caused by the freshwater stingray. Seven of those affected were men. The median age was 30 years (range: 8 to 44). Antioquia and Caquetá reported 58% of the accidents recorded. Although the empirical use of antibiotics was done in the majority of cases, only four of them documented infectious skin and soft tissue complications that required intrahospital treatment. Conclusion Poisoning by freshwater and saltwater animals occurs in Colombia. Although there were few cases in 3 years, the low national registry may be relevant, meriting greater preparation of medical personnel, and more research in this area.(AU)

[Epidemiology of aquatic animal poisonings reported to a Colombian toxicology control center]. / Epidemiología de los envenenamientos por animales acuáticos reportados a un centro de control toxicológico colombiano.

OBJECTIVE: To characterize the cases of poisoning by marine and freshwater animals treated by the PCC of the University of Antioquia, Colombia, between 2016 and 2018. METHODOLOGY: An observational, retrospective study using the PCC database that contains the demographic and clinical characteristics reported during the medical management during a toxicological emergency. Period analyzed was from January 1st, 2016 to December 31st, 2018. The cases identified as poisoning by aquatic animals had telephone follow-up to understand if there were complications or sequelae. RESULTS: Twelve cases were reported in the period, eleven of them caused by the freshwater stingray. Seven of those affected were men. The median age was 30 years (range: 8 to 44). Antioquia and Caquetá reported 58% of the accidents recorded. Although the empirical use of antibiotics was done in the majority of cases, only four of them documented infectious skin and soft tissue complications that required intrahospital treatment. CONCLUSION: Poisoning by freshwater and saltwater animals occurs in Colombia. Although there were few cases in 3 years, the low national registry may be relevant, meriting greater preparation of medical personnel, and more research in this area.

OBJETIVO: Caracterizar los casos de envenenamiento por animales marinos y dulceacuícolas atendidos por el CCT de la Universidad de Antioquia, Colombia, entre 2016 y 2018. METODOLOGÍA: Estudio observacional, retrospectivo, realizado a partir de la base de datos del CCT, que contiene las características demográficas y clínicas reportadas durante el manejo médico de cada emergencia toxicológica asesorada. El periodo analizado fue desde el 1 de enero del 2016 al 31 de diciembre de 2018. Los casos identificados como envenenamiento por animales acuáticos tuvieron seguimiento telefónico para saber si hubo complicaciones o secuelas. RESULTADOS: En el periodo se reportaron doce casos, once de ellos ocasionados por rayas dulceacuícolas. Siete de los afectados fueron hombres. La mediana de edad fue 30 años (rango: 8 a 44). En Antioquia y Caquetá se registraron 58% de los accidentes reportados. Aunque el uso empírico de antibióticos se dio en la mayoría de los casos, solo en cuatro de ellos se documentaron complicaciones infecciosas de piel y tejidos blandos, por lo cual requirieron tratamiento intrahospitalario. CONCLUSIÓN: El envenenamiento por animales de agua dulce y salada se presenta en Colombia. Aunque fueron pocos los casos en 3 años, el bajo registro nacional puede ser importante, pues amerita mayor preparación del personal médico y más investigación en este tema.