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Full-Text Articles in Medicine and Health Sciences
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 …
Management Of Self Poisoning, Alison L. Jones, Glyn Volans
Management Of Self Poisoning, Alison L. Jones, Glyn Volans
Alison L Jones
Around 15%20% of the workload of medical units and 10% of the workload of accident and emergency departments in the United Kingdom are due to self poisoning.1 2 Episodes of self poisoning in the United Kingdom continue to rise, particularly in young men, and alcohol is often taken with the overdose.2 In general the severity of poisoning has diminished over the past 10 years with the introduction of safer drugs, such as newer serotonin reuptake inhibitors, but the total number of deaths from poisoning in the United Kingdom remains steady at 4000 per year, and the commonest cause of death …
Doctors' Knowledge Of The Appropriate Use And Route Of Administration Of Antidotes In The Management Of Recreational Drug Toxicity, S Lidder, Hanna Ovaska, J.R.H Archer, S Greene, Alison Jones, Paul Dargan, David Wood
Doctors' Knowledge Of The Appropriate Use And Route Of Administration Of Antidotes In The Management Of Recreational Drug Toxicity, S Lidder, Hanna Ovaska, J.R.H Archer, S Greene, Alison Jones, Paul Dargan, David Wood
Alison L Jones
Background: Specific antidotes (eg, naloxone, flumazenil, cyproheptadine and benzodiazepines) are available for the management of certain recreational drug-induced toxicities. Some controversies surround the use of some of these antidotes, especially flumazenil in benzodiazepine toxicity. There are no previously published data on doctors’ knowledge of the use of these specific antidotes. Methods: A questionnaire survey was designed to determine internal/emergency medicine doctors’ knowledge of the appropriate use of antidotes in the management of clinical scenarios of acutely poisoned patients. For nine simulated clinical scenarios of acute toxicity from recreational drugs (benzodiazepines, cocaine, N-methyl-L-(3, 4-methylene-dioxyphenyl)-2-aminopropane (MDMA)-induced serotonin toxicity and opioids), they were …
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 …
Recent Advances In The Management Of Late Paracetamol Poisoning, Alison Jones
Recent Advances In The Management Of Late Paracetamol Poisoning, Alison Jones
Alison L Jones
Management of early paracetamol poisoning is dependent on prompt administration of N-acetylcysteine to patients whose plasma concentrations of paracetamol exceed the normal-risk or high-risk treatment lines. Paracetamol poisoning presenting after 15 h since ingestion, especially as fulminant hepatic failure, requires meticulous supportive care of organ dysfunction. The putative mechanisms of action of N-acetylcysteine and its practical use are discussed. The best prognostic marker for paracetamol poisoning in 'established hepatotoxicity' is the prothrombin time. Indications for liver transplantation in paracetamol poisoning and exclusion criteria are also discussed.
The Features And Management Of Poisoning With Drugs Used To Treat Parkinson's Disease, Alison Jones, A Proudfoot
The Features And Management Of Poisoning With Drugs Used To Treat Parkinson's Disease, Alison Jones, A Proudfoot
Alison L Jones
Drugs used in the treatment of patients with Parkinson's disease are occasionally taken in overdose. This review summarizes world-wide experience of poisoning with such drugs, and their features in overdosage, as no clinician will have seen a large number of cases, that the recognition and management of such rare cases may be optimized.
Review Article: Mechanisms And Management Of Hepatotoxicity In Ecstasy (Mdma) And Amphetamine Intoxications, Alison Jones, K Simpson
Review Article: Mechanisms And Management Of Hepatotoxicity In Ecstasy (Mdma) And Amphetamine Intoxications, Alison Jones, K Simpson
Alison L Jones
The social use of ecstasy (methylenedioxymethampheta-mine, MDMA) and amphetamines is widespread in the UK and Europe, and they are popularly considered as ‘safe’. However, deaths have occurred and hepatotox-icity has featured in many cases of intoxication with amphetamine or its methylenedioxy analogues such as ecstasy. Recreational use of these drugs presents an important but often concealed cause of hepatitis or acute liver failure, particularly in young people. The patterns of liver damage and multiple putative mechanisms of injury are discussed. Recognition of the aetiological agent requires a high index of suspicion. Optimum management of the resultant liver damage, including the …
Initial Management Of Poisoned Patients In The Out-Of-Hospital Environment, Alison Jones
Initial Management Of Poisoned Patients In The Out-Of-Hospital Environment, Alison Jones
Alison L Jones
Poisoning and suspected poisoning are very common problems in pre-hospital emergency care. The challenge is to identify the 1-2% of individuals who have taken sufficient toxin to be at risk of developing serious sequelae and use and develop effective methods of preventing such sequelae. Few randomised controlled clinical trials are available, and management decisions often have to be made on isolated case reports in the more unusual cases of poisoning. Care of the unconscious poisoned patient includes care of the airway, breathing, and circulation. Clues to the aetiology of poisoning in such cases may be gained from clinical signs which …
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 …
Pitfalls In The Management Of The Poisoned Patient, Mary Kerins, Paul Dargan, Alison Jones
Pitfalls In The Management Of The Poisoned Patient, Mary Kerins, Paul Dargan, Alison Jones
Alison L Jones
Acute poisoning is a common problem worldwide. In the United Kingdom (UK) it accounts for an estimated 10–20% of acute medical admissions and 5–10% of the workload of Accident and Emergency (A&E) departments.1–4 Episodes of self-poisoning in the UK continue to rise, with the rates being among the highest in Europe.5–7 The severity of poisoning has decreased over the past decade with the introduction of safer drugs, such as the selective serotonin reuptake inhibitors, but the total number of deaths from poisoning in the UK remains unchanged at more than 3,000 per year.2 This paper will address common pitfalls in …
Management Of Paracetamol Poisoning, Paul Dargan, Alison Jones
Management Of Paracetamol Poisoning, Paul Dargan, Alison Jones
Alison L Jones
Paracetamol is the most common substance involved in self-poisoning in the UK. The main advances made over the past five years in the management of early paracetamol poisoning, identification of risk factors for paracetamol poisoning, understanding of the mechanisms and management of late paracetamol poisoning and issues concerning the prevention of paracetamol poisoning are discussed.
Recent Advances In The Management Of Poisoning, Alison Jones
Recent Advances In The Management Of Poisoning, Alison Jones
Alison L Jones
Self-poisoning is responsible for at least 20% of acute admissions to hospital in the UK (1–2) and represents a significant workload for healthcare Professionals worldwide. The topics in this article have been chosen as they represent significant changes in understanding of clinical toxicology working practices over the last three years. Thus recent advances in the management of poisoning by tricyclic antidepressants, ethylene glycol and methanol, salicylates and carbon monoxide are covered. Tricyclic antidepressant overdoses represent approximately half the poisoned patient workload of Intensive Care Units. Carbon monoxide has been chosen because it is the number one cause of death by …
Use Of An Ivc Filter In The Management Of Ivc Thrombosis - "Letter", Alison Jones
Use Of An Ivc Filter In The Management Of Ivc Thrombosis - "Letter", Alison Jones
Alison L Jones
No abstract provided.
The Management Of Tricyclic Antidepressant Poisoning: The Role Of Gut Decontamination, Extracorporeal Procedures And Fab Antibody Fragments, Paul I. Dargan, Mark G. Colbridge, Alison Jones
The Management Of Tricyclic Antidepressant Poisoning: The Role Of Gut Decontamination, Extracorporeal Procedures And Fab Antibody Fragments, Paul I. Dargan, Mark G. Colbridge, Alison Jones
Alison L Jones
Although there have been descriptive, uncontrolled clinical reports of removal of tablet debris by gastric lavage, there have been no clinical studies that have demonstrated that this has any impact on outcome in patients with tricyclic antidepressant (TCA) poisoning. There is also the possibility that lavage may increase drug absorption by pushing tablets into the small intestine. Furthermore, gastric lavage in patients with TCA poisoning may induce hypoxia and a tachycardia potentially increasing the risk of severe complications such as arrhythmias and convulsions. In view of the paucity of evidence that gastric lavage removes a significant amount of drug and …
Features And Management Of Poisoning With Modern Drugs Used To Treat Epilepsy, Alison Jones, A Proudfoot
Features And Management Of Poisoning With Modern Drugs Used To Treat Epilepsy, Alison Jones, A Proudfoot
Alison L Jones
Patients become poisoned with anticonvulsant drugs postulated to result from post-ictal depression which in a variety of ways (Table 1).1 The prevalence of may persist for several days after a seizure. self poisoning and suicide amongst epileptics is many Anticonvulsant poisoning in children is a significtimes higher than that of the non-epileptic popula- ant problem,4 and not surprisingly, epileptics usually tion.2 There are many possible reasons for this, ingest their own anticonvulsants.3,4 Thus the prevalincluding social stigma, employment and marital ence of acute, carbamazepine overdosage appears difficulties, frequent or poorly controlled seizures, to be rising as its role as a …
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 …
Improvement In The Management Of Acutely Poisoned Patients Using An Electronic Database, Prospective Audit And Targeted Educational Intervention, S Greene, David Wood, I Gawarammana, C Warren-Gash, Nick Drake, Alison Jones, Paul Dargan
Improvement In The Management Of Acutely Poisoned Patients Using An Electronic Database, Prospective Audit And Targeted Educational Intervention, S Greene, David Wood, I Gawarammana, C Warren-Gash, Nick Drake, Alison Jones, Paul Dargan
Alison L Jones
Problem: The need to improve the clinical assessment and management of acutely poisoned patients presenting to an NHS hospital emergency department (ED). Design: Creation of an electronic clinical toxicology database to prospectively collect all aspects of clinical information on poisoned-patient presentations. Systematic analysis of collated information to identify shortfalls in patient assessment and management. Bimonthly audit meetings, and design and implementation of educational interventions to address identified shortfalls. Ongoing audit to demonstrate continued improvement in patient care. Background and setting: ED in tertiary-level inner-city London teaching hospital. Study conducted by staff from the ED and clinical toxicology service. Key measures …
Use Of An Ivc Filter In The Management Of Ivc Thrombosis Occurring As A Complication Of Acute Pancreatitis, Alison Jones, D Ojar, D Redhead, A Proudfoot
Use Of An Ivc Filter In The Management Of Ivc Thrombosis Occurring As A Complication Of Acute Pancreatitis, Alison Jones, D Ojar, D Redhead, A Proudfoot
Alison L Jones
Vascular thrombosis and hypercoagulable states complicating pancreatitis are thought to be due to release of proteolytic enzymes from the pancreas and direct vasculitis. Inferior vena cava (IVC) thrombosis is an extremely rare complication o f chronic [1] and acute [2,3] pancreatitis.