A letter on "Thallium concentrations in body fluids and tissues in a fatal case of thallium poisoning".
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Humans↗
Biomedical subjects
A Heath
Publications and source records attributed to A Heath.
[Prenalterol, hydrocortisone and insulin can be valuable in amitriptyline poisoning].
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Aged↗
Effects of self poisoning with maprotiline.
Self poisoning with maprotiline was studied in 41 patients (43 episodes) consecutively admitted to an intensive care unit. Thirty five patients had taken more than one drug or alcohol. Fifteen patients were in coma grade III or IV; 17 patients were still not conscious after 24 hours in the intensive care unit. Among six patients given ventilation the mean duration of ventilation in the five who recovered was 36 hours. Three patients had a cardiorespiratory arrest, and one patient died. Twenty eight patients had a QRS interval of 100 ms or more, and 15 patients had seizures. In six patients seizures were precipitated by physostigmine. Cardiotoxicity after overdosage of maprotiline is equal to if not greater than that found after overdosage of conventional tricyclic antidepressants. Overdosage of maprotiline is more often associated with seizures than overdosage with tricyclic antidepressants. Physostigmine further increases the risk of seizures and should not be used in cases of overdosage of maprotiline.
Adult↗
Inotropic effect of prenalterol in amitriptyline poisoning.
A case of severe amitriptyline poisoning with grade IV coma, seizures, bradycardia and hypotension who did not respond to dopamine was successfully treated with prenalterol, a new cardioselective beta-agonist. The case is discussed with respect to plasma concentrations of dopamine, prenalterol and amitriptyline. Prenalterol, hydrocortisone and insulin may be useful as inotropic agents in tricyclic poisoning where dopamine fails to provide an adequate response.
Adrenergic beta-Agonists↗
Beta-adrenoceptor blocker toxicity: clinical features and therapy.
Therapy for severe beta-blocker poisoning should be based upon careful supportive therapy. In most cases of poisoning, elimination techniques cannot be expected to remove significant amounts of the drug. Inotropic drugs such as isoproterenol, prenalterol and glucagon in adequate (i.e. large) doses may be necessary to counteract cardiac failure.
Absorption↗
Lidocaine and amitriptyline interaction during experimental haemoperfusion.
Displacement of amitriptyline by lidocaine was studied during haemoperfusion (HP) in five beagle dogs. Clearance of amitriptyline during HP was 0.93, although the amount of amitriptyline removed was only 2% of the given dose. Lidocaine does therefore not improve amitriptyline yield during HP. Clearance of lidocaine during HP was 0.99. Almost 13% of the lidocaine given intravenously was removed by HP. Lidocaine did not improve myocardial performance during HP in amitriptyline-intoxicated dogs. At necropsy the highest concentrations of amitriptyline in this model were found in the brain and the lung. The amitriptyline/nortriptyline ratio was lowest in the liver and lung, suggesting that these two organs are major sites of metabolism.
Amitriptyline↗
Treatment of oral theophylline poisoning.
Two patients, 15 and 20 years old, were admitted after an overdose of theophylline in a slow-release preparation. The gradual occurrence of clinical symptoms reflected the slow gastrointestinal absorption of the drug, and therefore active treatment was not started until 10 and 12 hours after intake, respectively. Peak s-concentrations were 275 and 1295 mumol/l, respectively. One patient was treated with hemoperfusion only, whereas the more severely intoxicated patient was treated with combined hemoperfusion and hemodialysis. Only about 0.2 g theophylline was eliminated by hemodialysis in this patient compared to a calculated amount of 6.9 g by hemoperfusion. Severely theophylline-intoxicated patients should be treated with supportive therapy and hemoperfusion.
Adolescent↗
Elimination methods in neurotoxicology.
In addition to supportive care and, if appropriate, antidote therapy, the prognosis in some poisonings can be improved by increasing drug or toxin elimination. Such methods include peroral activated charcoal, forced diuresis, peritoneal and hemodialysis, and hemoperfusion. The choice of method should be based upon a knowledge of the pharmacology of the drug or toxin itself and the limitations of the technique employed. This review focuses on the pharmacological principles involved, outlining the limitations and indications for these techniques in toxicology.
Charcoal↗
Methanol poisoning.
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Alcoholic Intoxication↗
Clinical aspects of tricyclic antidepressant poisoning.
Self-poisoning with antidepressant drugs was studied retrospectively in 225 patients admitted to an intensive care unit. Amitriptyline accounted for the overwhelming majority of cases (70%); 106 patients (47%) had taken two or more drugs, in 81 patients (36%) ethanol was found in the blood. Four patients (2%) died. On admission, 111 patients (49%) were unconscious (grade III). A further 30 patients (13%) were in grade IV coma, and of these 27 had taken amitriptyline. Twenty-four hours after admission, 22 patients (10%) remained in coma. Thirty-six patients (16%) required assisted ventilation. Nineteen patients (8%) had convulsions and 6 (3%) aspired stomach contents. Sixty-one patients (27%) had a widened QRS interval exceeding 100 msec, 18 (30%) of them required assisted ventilation, 21 (34%) were in stage IV coma and 15 (25%) had convulsions. This relationship between a widened QRS interval and the severity of intoxication should be considered in the initial assessment of patients with tricyclic antidepressant poisoning.
Adolescent↗
Absorption of beta-adrenoceptor antagonists to Amberlite resin.
The adsorption of beta-adrenoceptor blockers and the partial beta-adrenoceptor agonist prenalterol was studied in an in vitro haemoperfusion (HP) model. Metoprolol, alprenolol, propranolol and prenalterol adsorb well from the blood to the resin with extraction ratios nearing 1.0. Extraction ratio for practolol was 0.68 and for atenolol 0.49. Protein binding has little effect on the degree of adsorption, which is more dependent on water solubility.
Adrenergic alpha-Antagonists↗
Thallium poisoning--toxin elimination and therapy in three cases.
Three cases of thallium poisoning occurred within the same family after eating a meal of poisoned sour milk. The 58 year old mother died after four days cardiovascular insufficiency. Massive thallium concentrations were found in blood, urine, liver and kidney. The 59 year old father presented after four days with a neurology typical for classic thallotoxicosis with potentially lethal blood thallium levels. This patient recovered after therapy including Prussian Blue, forced diuresis and two six hour hemoperfusions with a charcoal column. Urinary elimination of thallium over two weeks was almost 300 mg, whereas a maximum total of 63 mg were removed with hemoperfusion. A retrospective estimate of the total dose ingested and the large distribution volume of thallium suggest that hemoperfusion did not affect the course of the intoxication. The 28 year old son, later convicted for homicide, was admitted on the tenth day after the meal with very discrete neurological symptoms. This patient had low blood and urine thallium levels. He recovered uneventfully after treatment with Prussian Blue and forced diuresis. However, both surviving patients developed alopecia after two weeks. All three patients had raised liver transaminases. Intensive therapy with gut decontamination, Prussian Blue and forced diuresis should be the mainstay of therapy.
Adult↗
Prenalterol as an antidote to massive doses of metoprolol--a cardiovascular study in the dog.
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Adrenergic beta-Agonists↗
Treatment of antidepressant poisoning with resin hemoperfusion.
1 The object of this study was to evaluate hemoperfusion in tricyclic antidepressant (TCA) poisoning. 2 Eight patients with severe TCA-poisoning and one patient with maprotiline poisoning were treated with resin hemoperfusion (HP). All patients were in Grade III or Grade IV coma with a QRS interval of 100 ms or greater. Hemoperfusion was started and continued until a satisfactory clinical response was obtained or for up to a maximum of 4 h. 3 Clearance values and extraction ratios were calculated during HP. The extraction ratio for all drugs was high (0.91-0.98) showing an effective clearance of these drugs from the blood compartment. After termination of HP a rebound effect of blood concentrations was seen in five cases. The total amount of the drug recovered was in no case greater than 3.1% of the estimated amount ingested. 4 It is therefore difficult to ascribe the clinical improvement seen in these patients during HP to the removal of significant amounts of the drug taken.
Adult↗
Treatment of podophyllin poisoning with resin hemoperfusion.
1 A 43-year-old man was admitted in a coma after oral ingestion of a suspected lethal dose of podophyllin solution in alcohol. 2 Hemoperfusion with a resin filter was started 7 h after ingestion. Hemoperfusion rapidly decreased plasma concentrations of podophyllotoxin with an extraction ratio of 0.76 over the filter. The relatively low plasma concentrations of podophyllotoxin and consequently small amount removed might be explained by the rapid metabolism of the drug to an unknown derivate. 3 This metabolite was completely cleared during passage over the filter, suggesting the removal of significant amounts of podophyllotoxin metabolites. 4 No neurological deficit was observed before or after hemoperfusion. At a two-month follow-up the patient remained healthy. Hemoperfusion may possibly prevent the development of coma and neurologic deficit with loss of deep tendon reflexes.
Adult↗
Resin hemoperfusion in chloroquine poisoning.
A 46-year-old woman was admitted after ingestion of 10 g chloroquine phosphate. The patient's clinical condition deteriorated with characteristic ECG changes, low blood pressure, and respiratory depression. Resin hemoperfusion (HP) was started 4.5 h after admission at a flow of 250 mL/min for 4 h. Clearance over the resin column was 136 mL/min. Although the patient rapidly improved, a total of no more than 200 mg (2%) was removed. Total body clearance of chloroquine was increased by only 5% during HP. Treatment should therefore be directed toward aggressive supportive therapy rather than techniques to increase elimination.
Chloroquine↗
[Various aspects of the treatment of poisoning by tricyclic antidepressive agents].
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Anti-Arrhythmia Agents↗