RESUMO
BACKGROUND: Hospital laboratories currently lack the capacity to provide emergency determination of cholinesterase activity. METHODS: We have developed a hospital-based 3-tiered system to test plasma for butyrylcholinesterase (BChE) activity and whole blood for red cell acetylcholinesterase (AChE) activity using available technology and personnel. Interagency communications, toxidrome definition, and patient triage will be coordinated by the Connecticut Department of Public Health and the Poison Control Center. DATA: Initial BChE data documents good precision between institutions (coefficient of variation < 8%). SUMMARY: Laboratory testing of plasma or blood for cholinesterase activity is important in the management of nerve agent exposure and in ruling out disease in those with non-specific symptoms in the setting of a terrorist attack or accidental exposure. Rapid availability of strong hospital-based analytic support in a smoothly functioning network of clinical, public health, and laboratory services will facilitate overall regional response to chemical terrorism or large scale HazMat events.
Assuntos
Butirilcolinesterase/sangue , Substâncias para a Guerra Química/análise , Técnicas de Laboratório Clínico/métodos , Intoxicação/prevenção & controle , Acetilcolinesterase/sangue , Substâncias para a Guerra Química/intoxicação , Connecticut , Monitoramento Ambiental/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Eritrócitos/enzimologia , Humanos , Exposição por Inalação , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Projetos Piloto , Intoxicação/sangue , Intoxicação/enzimologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Terrorismo/prevenção & controleRESUMO
INTRODUCTION: This multiple-dose pharmacokinetic study has a randomized, double-blind, placebo-controlled, parallel-group design with three dosing regimens. Healthy subjects received repeated doses of acetaminophen (4 then 6 g/d or 4 then 8 g/d) or placebo. METHODS: The disposition of acetaminophen and its metabolites and the tolerability of increased acetaminophen doses over 3 days of continuous consumption were characterized. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities measured throughout the study were consistent across the acetaminophen 4, 6, and 8 g/d dose levels and with placebo. RESULTS: Serum aminotransferase activities did not exceed the upper limit of the reference range (ULRR), except for one subject with an AST of 43 U/L (ULRR, 42 U/L), which was not considered clinically significant. All doses were generally well tolerated. CONCLUSIONS: In a multiple-dose pharmacokinetics study of 4, 6, and 8 g/d of acetaminophen for 3 days, multiple aminotransferase determinations demonstrated no clinically important elevations at 1, 1.5, or 2 times the maximum recommended acetaminophen dose.
Assuntos
Acetaminofen/farmacocinética , Alanina Transaminase/sangue , Analgésicos não Narcóticos/farmacocinética , Aspartato Aminotransferases/sangue , Adolescente , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
The patient with acute extrapyramidal signs and symptoms presents a significant clinical challenge. We present the case of a young man who developed an acute akathisia and dystonia after inadvertent overdose of olanzapine (Zyprexa) in the setting of a recent discontinuation of fluoxetine. The receptor chemistry and mechanisms pertinent to his presentation are reviewed. An analysis of the literature indicates that a broad incidence range is cited for the extrapyramidal effects of these medications. We suggest a diagnostic and therapeutic approach to the undifferentiated patient presenting with extrapyramidal signs and symptoms. The possibility of neuroleptic malignant syndrome (NMS), serotonin syndrome (SS), tricyclic overdose, and cocaine abuse should be considered in a patient with extrapyramidal signs and symptoms, given the potential for complications. An emphasis is placed on the need for carefully verbalized discharge instructions to avoid a potential untoward outcome.