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Full-Text Articles in Medicine and Health Sciences
Poisoning & Overdose, Alison Jones
Poisoning & Overdose, Alison Jones
Alison L Jones
Many poisoned patients recover without specific management other than supportive care. A minority have life-threatening toxicity. In assessing the poisoned patient It is important to ensure adequate Airway. Breathing and circulation, take an adequate history and undertake a full clinical examination. Tablets, bonles, syringes, aerosol contai"lers and other items found with or near the patient should be retained, although it Is usually best to analyse biological specimens (usually blood andlor urine) if analytical confirmation of exposure Is required.
Emergency Room Use Of Opioid Antagonists In Drug Intoxication And Overdose, Simon Clarke, Rob Torok, Paul Dargan, Alison Jones
Emergency Room Use Of Opioid Antagonists In Drug Intoxication And Overdose, Simon Clarke, Rob Torok, Paul Dargan, Alison Jones
Alison L Jones
Opioid receptor antagonists are effective at reversing the clinical features of opioid toxicity; however, if administered overenthusiastically, they can precipitate acute withdrawal symptoms (AWS) in regular opioid users. These symptoms may cause the patients to discharge themselves against medical advice and they are in danger of renarcotization either due to the effect of the antagonists wearing off or because of the patients seek further opioids, often in larger doses, to overcome AWS. Clinicians treating opioid overdose are therefore walking a clinical tightrope between undertreating the patient and precipitating AWS. The three opioid antagonists that have been licensed for clinical use …
Relative Safety Of Hyperinsulinaemia/Euglycaemia Therapy In The Management Of Calcium Channel Blocker Overdose: A Prospective Observational Study, S Greene, I Gawarammana, David Wood, Alison Jones, Paul Dargan
Relative Safety Of Hyperinsulinaemia/Euglycaemia Therapy In The Management Of Calcium Channel Blocker Overdose: A Prospective Observational Study, S Greene, I Gawarammana, David Wood, Alison Jones, Paul Dargan
Alison L Jones
Objective: To examine the clinical safety of hyperinsulinaemia/ euglycaemia therapy (HIET) in calcium channel blocker (CCB) poisoning. Design: A prospective observational study examining biochemical and clinical outcomes of a HIET protocol administered under local poisons centre guidance. Setting: Critical care settings. Patients: Seven patients with significant CCB toxicity [systolic blood pressure (BP) < 90 mmHg] treated with HIET. Interventions: HIET was commenced after correction of any pre-existing hypoglycaemia ([blood glucose]< 65 mg/dl) or hypokalaemia ([K+] < 3.5 mmol/l). A quantity of 50 ml of 50% intravenous dextrose was followed by a loading dose (1 unit/kg) of intravenous short-acting insulin and an insulin maintenance infusion (0.5–2.0 units/kg/h). Euglycaemia was maintained using 5–10% dextrose infusions. Potassium was maintained within low normal range (3.8–4.0 mmol/l). Measurements and results: Six patients survived. All patients received fluids, calcium, and conventional inotropes. Three patients (who all ingested diltiazem) received an insulin-loading dose; all experienced a significant sustained rise in systolic BP (> 10 mmHg) during the first hour of HIET. Systolic BP did not increase significantly in four patients who did not receive insulin loading. Single episodes of non-clinically significant biochemical hypoglycaemia and hypokalaemia were recorded in one and two patients respectively. Hypoglycaemia was not recorded in any patient administered …
Poisoning And Overdose, Alison Jones
Paracetamol (Acetaminophen) Overdose, Alison Jones
Paracetamol (Acetaminophen) Overdose, Alison Jones
Alison L Jones
A 23-year-old woman. who is 34 weeks pregnant with her first child, is seen In the Emergency Department after taking 28 paratetamol (500 mg) tablets 2 h ago. She is 62 kg in weight. She did not co-ingest any other drug or alcohol. She complains of nausea and intermittent vomiting. but this has been consistent throughout her pregnancy.
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Alison L Jones
Background: Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK. Methods: A retrospective case note study from 1 February 2001 to 31 January 2002 was undertaken at the emergency department of St. Thomas’ Hospital, London. Records were reviewed and information on demographic data, history, details of salicylate …
A Young Woman Who Has Taken An Overdose Of Paracetamol (Acetaminophen), Alison Jones
A Young Woman Who Has Taken An Overdose Of Paracetamol (Acetaminophen), Alison Jones
Alison L Jones
No abstract provided.
Plasma Salicylate Concentrations Following Overdose; Are They Worth It ?, David Muir Wood, Alison Jones, Paul Dargan
Plasma Salicylate Concentrations Following Overdose; Are They Worth It ?, David Muir Wood, Alison Jones, Paul Dargan
Alison L Jones
Treatment following salicylate ingestion is determined by clinical evidence of toxicity. Previous studies have shown that routine measurement of plasma salicylate concentrations in all overdose patients is unnecessary except in those with clinical features suggestive of salicylate poisoning or in those who are unable to give an accurate history [1]. This retrospective study evaluates whether plasma salicylate concentrations are appropriately measured. A retrospective study of all plasma salicylate concentrations measured in St Thomas’ Hospital Accident and Emergency department from 1 February 2001 to 31 January 2002 was conducted. Admission record cards were surveyed for history of salicylate ingestion, clinical features …
Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte
Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte
Alison L Jones
Background: Use of psychotropic drugs is known to impair driving and increase the risk of road traffic accidents. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. Most patients who take psychotropic drug overdoses are discharged within 48 hours, while they still have possible subclinical drug effects. Objective: Using a self-controlled case series design, we aimed to determine whether patients with psychotropic drug overdose are at a higher risk of a traffic accident in the period following discharge compared with a control period not associated with hospital-treated drug overdose. Methodology: Using the New South …
How Feasible Is It To Conform To The European Guidelines On Administration Of Activated Charcoal Within One Hour Of An Overdose?, A Karim, S Ivatts, Paul Dargan, Alison Jones
How Feasible Is It To Conform To The European Guidelines On Administration Of Activated Charcoal Within One Hour Of An Overdose?, A Karim, S Ivatts, Paul Dargan, Alison Jones
Alison L Jones
Objectives—The European and American position statement on the use of activated charcoal recommends its administration within an hour of ingestion of a charcoal binding poison. But in reality, this time limit is difficult to follow for the majority of poisoned patients. This study aimed to examine the treatment of acutely poisoned patients with activated charcoal in an accident and emergency (A&E) department. Methods—63 patients who had taken potentially serious overdoses and required hospital admission from a London teaching hospital A&E department were identified over a six month period. The patients’ case notes were analysed for age, sex, substances taken, and …
Paracetamol Overdose: An Evidence Based Flowchart To Guide Management, Craig Wallace, Paul Dargan, Alison Jones
Paracetamol Overdose: An Evidence Based Flowchart To Guide Management, Craig Wallace, Paul Dargan, Alison Jones
Alison L Jones
A flowchart for the management of patients with paracetamol poisoning is presented to help clinicians in the emergency department. Paracetamol is the commonest drug taken in overdose in the United Kingdom. While the management of early paracetamol poisoning is straightforward, the management of late presenting cases, cases presenting after a staggered overdose, and patients with risk factors for paracetamol poisoning can be much more complex. The authors have developed and present here an evidence based flowchart that will guide clinicians step by step through the investigation and treatment of all patients presenting to hospital after this common, but often difficult …
An Evidence Based Flowchart To Guide The Management Of Acute Salicylate (Aspirin) Overdose, Paul Dargan, Craig Wallace, Alison Jones
An Evidence Based Flowchart To Guide The Management Of Acute Salicylate (Aspirin) Overdose, Paul Dargan, Craig Wallace, Alison Jones
Alison L Jones
Objective: To develop a flowchart to be used as a tool to guide clinicians step by step through the management of salicylate poisoning. Methods: A comprehensive literature search was carried out. Results: The evidence base was used to develop a management flowchart that guides the clinician through the three main steps in caring for the patient with salicylate poisoning: preventing further absorption, assessing the severity of poisoning and, where appropriate, increasing elimination. Conclusions: Salicylate poisoning can result in severe morbidity and mortality and this flowchart provides an evidence based guideline that will guide clinicians through the management of patients presenting …
Cognitive Impairment In Patients Clinically Recovered From Central Nervous System Depressant Drug Overdose, Tharaka Dassanayake, Patricia Michie, Alison Jones, Gregory Carter, Trevor Mallard, Ian Whyte
Cognitive Impairment In Patients Clinically Recovered From Central Nervous System Depressant Drug Overdose, Tharaka Dassanayake, Patricia Michie, Alison Jones, Gregory Carter, Trevor Mallard, Ian Whyte
Alison L Jones
Central nervous system depressant drugs (CNS-Ds) are known to impair cognitive functions. Overdose of these drugs is common, and most of the hospital-treated patients are discharged within 24 to 48 hours. No previous studies have examined whether they have residual impairment at the time of discharge. Our aim was to evaluate whether patients with CNS-D overdose are impaired in cognitive domains important in daily activities at that time. We compared visuomotor skills (Trail-Making Test A and Choice Reaction Time), executive functions (viz attentional set-shifting: Trail-Making Test B; and planning: Stockings of Cambridge Task from the Cambridge Neuropsychological Test Automated Battery), …
Status Epilepticus Following Intentional Overdose Of Fluvoxamine: A Case Report With Serum Fluvoxamine Concentration, David Wood, Yadhunanthanan Rajalingam, S Greene, Phillip E. Morgan, David Gerrie, Alison Jones, Paul Dargan
Status Epilepticus Following Intentional Overdose Of Fluvoxamine: A Case Report With Serum Fluvoxamine Concentration, David Wood, Yadhunanthanan Rajalingam, S Greene, Phillip E. Morgan, David Gerrie, Alison Jones, Paul Dargan
Alison L Jones
Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) that is used in the management of depression and obsessive compulsive disorders. We report a patient with status epilepticus requiring quadruple anti-convulsant treatment following a fluvoxamine overdose. Case Report. A 25-year-old female presented with drowsiness at 12 hours following deliberate ingestion of 9.6 grams of fluvoxamine. Sixteen hours after ingestion, she developed status epilepticus that required treatment with benzodiazepines (lorazepam and midazolam), thiopentone, phenytoin and phenobarbitone. Her serum fluvoxamine concentration on presentation was 1970 μg/L (therapeutic 160–220 μg/L) and routine toxicological screening was negative for other drugs. She was discharged home after …
Metaraminol (Aramine(R)) In The Management Of A Significant Amlodipine Overdose, David Wood, K Wright, Alison Jones, Paul Dargan
Metaraminol (Aramine(R)) In The Management Of A Significant Amlodipine Overdose, David Wood, K Wright, Alison Jones, Paul Dargan
Alison L Jones
Objective: To report a patient with a significant amlodipine self-poisoning who failed to clinically respond to conventional treatment and was managed with metaraminol (Aramine†). Patient: A 43-year old male presenting after ingestion of 560 mg amlodipine, who failed to respond clinically to treatment with fluid resuscitation, calcium salts, glucagon and norepinephrine/epinephrine inotropic support. Main results : Following a loading bolus of 2 mg and intravenous infusion (83 mg/min) of metaraminol (Aramine.R) there was improvement in his blood pressure, cardiac output and urine output. Conclusions: This is the first case report of the beneficial use of metaraminol (aramine) in the management …
Glucagon Use In B Blocker Overdose, Niall O'Connor, S Greene, Paul Dargan, Alison Jones
Glucagon Use In B Blocker Overdose, Niall O'Connor, S Greene, Paul Dargan, Alison Jones
Alison L Jones
The Best Evidence Topic Reports series is intended to provide evidence-based answers to clinical questions. The recent best evidence topic report by Boyd1 concluded that there is not enough evidence to support the use of glucagon in b blocker overdose. However, clinical toxicology is an area in which the evidence basis is often lacking and one therefore needs to rely on a combination of practical experience, case reports and assessment of biological plausibility
Amfetamine Overdose, Alison Jones, Sheree Kable
Amfetamine Overdose, Alison Jones, Sheree Kable
Alison L Jones
Large burden of dependency and toxicity worldwide stems from both legitimate and recreational ingestion of drug by nearly 25 million users annually. Overdose and toxicity strike inconsistently among new, occasional, chronic, and binge users. Intentional overdose is also encountered. Tachycardia, hyperthermia, volume depletion, agitation, seizures, and rhabdomyolysis are sentinel findings. Diagnosis facilitated by high index of suspicion and urine amfetamine screening. Treatment is initiated before receiving laboratory results. Hyperthermia often requires close monitoring and pharmacotherapy appropriate to an intensive care setting. Despite relative lack of short-term consequences (most victims recover fully), there are legitimate concerns that chronic use may lead …