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Biomedical subjects

E M Caravati

Publications and source records attributed to E M Caravati.

At least 19 recordsLinked to original sources
PubMed2001

Esophageal laceration and charcoal mediastinum complicating gastric lavage.

A 19-year-old woman underwent multiple attempts at orogastric lavage before success 5 h after ingesting approximately 24 grams of ibuprofen in a suicide attempt. Activated charcoal was administered via the lavage tube. She vomited charcoal shortly after administration and began experiencing difficulty breathing and an increase in the pitch of her voice. A chest X-ray study showed a widened mediastinum, pneumopericardium, and subcutaneous emphysema consistent with esophageal perforation that was confirmed by computed tomography scan. Surgical exploration revealed a tear in the proximal posterior esophagus with charcoal in the posterior mediastinum. She remained intubated for 7 days and was discharged 14 days after admission. This is a report of esophageal perforation with activated charcoal contamination of the mediastinum after gastric lavage. The risks and benefits of this procedure should be carefully considered in each patient prior to its use. Awake patients should be cooperative with the procedure to minimize any risk of trauma to the oropharynx or esophagus.

Adult↗
PubMed2000

Unintentional acetaminophen ingestion in children and the potential for hepatotoxicity.

OBJECTIVE: Children who unintentionally ingest acetaminophen are often referred to health care facilities for evaluation. Criteria for referral are not well defined and the vast majority of these exposures result in nontoxic serum concentrations. The objective of this study was to determine the incidence of potentially hepatotoxic serum concentrations and to more clearly define referral criteria for these patients. METHODS: A prospective evaluation of all childhood (age 1-72 months) single ingestions of acetaminophen-containing products was performed by the Utah Poison Control Center. All patients ingesting 140 mg/ kg or greater or an unknown amount were referred for medical evaluation. Patients who ingested greater than 100 mg/kg were advised to administer syrup of ipecac at home if less than 1 hour since ingestion. Activated charcoal was recommended within 2 hours of ingestion if the patient was already at a health care facility. The potential for hepatotoxicity was assessed according to the Rumack-Matthew nomogram. RESULTS: Inclusion criteria were met by 1015 patients. The mean age was 28 +/- 12 months and mean dose was 213 +/- 148 mg/ kg. Decontamination with ipecac, gastric lavage, or activated charcoal within 2 hours of ingestion occurred in 81% of patients ingesting greater than 140 mg/kg or an unknown amount. Six patients (0.59%, 95% CI 0.12-1.16%) had "possible" or "probable" hepatotoxic serum concentrations and all had ingested greater than 200 mg/kg or an unknown amount. There were 423 patients who ingested between 100 and 200 mg/kg and none had potentially hepatotoxic serum concentrations (upper 95% CL 0.71%). CONCLUSIONS: Children who ingest between 140-200 mg/kg of acetaminophen and demonstrate ipecac-induced emesis within 60 minutes may be safely managed at home. Patients ingesting greater than 200 mg/kg or an unknown amount should be referred for a serum acetaminophen concentration.

Acetaminophen↗
PubMed1996

Rhabdomyolysis: a rare adverse effect of diphenhydramine overdose.

Drug- and toxin-induced rhabdomyolysis is a nonspecific clinical syndrome resulting from the release of skeletal muscle cell contents into the plasma and urine. Antihistamine drugs are the active ingredients in a number of over-the-counter preparations and are frequently ingested in suicide attempts. We report rhabdomyolysis as a rare adverse effect of diphenhydramine toxicity in a 29-year-old man who ingested an unknown quantity of an over-the-counter sleep preparation in a suicide attempt. The patient had documented toxic concentration of diphenhydramine in his cerebrospinal fluid and no history of seizures, coma, or hypothermia. A high index of suspicion and an evaluation for rhabdomyolysis is warranted in antihistamine toxicity.

Adult↗
PubMed1995

Massive dextromethorphan ingestion and abuse.

The case of a 23-year-old man who was acutely intoxicated on dextromethorphan and who was chronically addicted to the drug is described. He consumed the highest daily dose for the longest duration yet reported in the world's English-language medical literature. Toxicity, abuse potential, and therapy of dextromethorphan intoxication are discussed.

Adult↗
PubMed1995

Cardiovascular effects of carbamazepine toxicity.

STUDY OBJECTIVE: To evaluate the cardiovascular effects of carbamazepine in patients presenting to the emergency department. DESIGN: A retrospective case series from February 1, 1985, to July 30, 1993. SETTING: Six urban EDs. PARTICIPANTS: Seventy-two adult and pediatric patients with serum carbamazepine concentrations greater than 12 micrograms/mL and concurrent 12-lead ECGs. RESULTS: The mean carbamazepine level was 24 micrograms/mL (range, 12.6 to 55 micrograms/mL). Minor ECG abnormalities were noted but no clinically significant arrhythmias were found. No correlation was found between carbamazepine concentration and heart rate or PR, QRS, or corrected QT intervals. Four adult patients had transient hypotension. CONCLUSION: Clinically significant cardiovascular toxicity occurs rarely in patients with toxic carbamazepine concentrations. ECG findings do not correlate with serum carbamazepine concentration.

Adolescent↗
PubMed1994

Gila monster envenomation.

Envenomation from the bite of the Gila monster (Heloderma suspectum) has been reported in the medical literature only nine times since 1956. We present an additional four cases to better define the signs and symptoms of envenomation. Frequent clinical manifestations are pain, hypotension, tachycardia, nausea, and vomiting. Gila monster teeth remaining in the wound are not detectable by soft tissue radiography. In our series, hypotension responded well to i.v. crystalloid fluid administration. We recommend at least 6 hours of observation after the bite to assess the potential for systemic toxicity.

Adult↗
PubMed1994

Hydrogen peroxide exposure--325 exposures reported to a regional poison control center.

Isolated case reports have documented that hydrogen peroxide exposure can be associated with serious toxicity by various routes of exposure. The purpose of this study was to better delineate the epidemiology, medical outcome, and potential health hazards of hydrogen peroxide exposures to the general public. We performed a retrospective review of all exposures reported to a regional poison center over a 36 month period and found that of 95,052 exposures reported, 325 (.34%) were due to hydrogen peroxide. The pediatric population (< 18 years) accounted for 71% of hydrogen peroxide exposures and ingestion was the most common route of exposure (83%). Nausea and vomiting were the most common symptoms secondary to ingestion. Ocular and dermal exposures to dilute solutions resulted in transient symptoms without permanent sequelae. While most exposures by all routes resulted in a benign outcome (no effect or minor effect), there was a trend toward more severe outcomes in those who ingested a concentration greater than 10% (p = 0.011).

Administration, Oral↗
PubMed1992

Histamine antagonists in the treatment of acute allergic reactions.

STUDY OBJECTIVE: We compared the efficacies of cimetidine (an H2-receptor antagonist) and diphenhydramine (an H1-receptor antagonist) alone and in combination for alleviation of symptoms of acute allergic reactions. STUDY DESIGN AND INTERVENTIONS: In this prospective, randomized, double-blind study, patients and examiners assessed the severity of symptoms and signs of acute allergic reactions using a visual-analog scale before treatment and 30 minutes after treatment with 300 mg IV cimetidine and placebo, 50 mg IV diphenhydramine and placebo, or diphenhydramine plus cimetidine. SETTING AND PARTICIPANTS: Thirty-nine patients with acute allergic reactions presenting to two emergency departments of teaching hospitals. RESULTS: Of the 35 patients with pruritus, all 12 receiving diphenhydramine placebo had clinically significant relief compared with six of ten (60%) receiving cimetidine plus placebo (P = .03). Twelve of 13 (92%) receiving diphenhydramine plus cimetidine had relief, which was not a significant difference from the single drugs. Comparison of mean differences in pretreatment and post-treatment symptom scores (relief scores) among groups of patients with pruritus detected significantly more relief in the group receiving diphenhydramine plus placebo (80.3 +/- 7.4) than in those receiving cimetidine plus placebo (48.8 +/- 13.4) (P = .022). Of the 33 patients with urticaria, five of 11 (46%) receiving diphenhydramine plus placebo had clinically significant relief compared with eight of ten (80%) receiving cimetidine plus placebo (P = .18). Eleven of 12 patients (92%) receiving diphenhydramine plus cimetidine had relief, which is a significant difference from those receiving diphenhydramine plus placebo (P = .027). Comparison of mean relief scores in patients with urticaria detected significantly more relief in the group receiving diphenhydramine plus cimetidine (55.3 +/- 6.5) than in the group receiving diphenhydramine plus placebo (30.7 +/- 6.1) (P = .006). CONCLUSION: For treatment of pruritus from acute allergic reactions, diphenhydramine is more effective than cimetidine, and the combination offers no additional benefit. For treatment of acute urticaria, the combination of cimetidine and diphenhydramine is more effective than diphenhydramine alone.

Adult↗
PubMed1992

Prospective evaluation of adverse drug interactions in the emergency department.

STUDY OBJECTIVE: To determine the incidence and risk factors of clinically relevant adverse drug interactions occurring in emergency department patients. DESIGN: This report describes the drug interactions identified in an emergency population. Patients' drug regimens were evaluated prospectively at the time of the emergency evaluation. SETTING: University hospital ED. TYPE OF PARTICIPANTS: Convenience sample of 341 patients. INTERVENTIONS: Patients' medications on arrival at the ED (current medications) and medications initiated in the ED were entered into Hansten's computer-based drug interaction program to identify potential drug interactions. All potential drug interactions were brought to the attention of the attending emergency physician, whose subsequent actions were noted. Clinically relevant interactions were determined by a physician panel based on the ED attendings' actions, set criteria, and a review of hospital charts and four-week telephone follow-up of patients with potential drug interactions. MEASUREMENTS AND MAIN RESULTS: Three hundred forty patients were enrolled. One hundred thirty-five potential drug interactions were identified in 61 patients. Among these 135 potential drug interactions and 61 patients, we identified 20 clinically relevant interactions in 15 patients. The incidence of clinically relevant interactions was significantly higher (chi 2 = 3.95, P = .047) among current medication (9.7%) than medication added in the ED (3.1%). Clinically relevant interaction from both current and ED-initiated medication was associated with taking three or more medications on ED arrival (P = .016 and .045, respectively). Multiple regression showed age of 60 years or older to be the sole predictor of clinically relevant interaction among current medication (P = .05). CONCLUSION: Clinically relevant adverse drug interaction was significantly less from medication administered or prescribed in the ED than from current medication.

Age Factors↗
PubMed1991

Use of clinical toxicology resources by emergency physicians and its impact on poison control centers.

STUDY OBJECTIVE: The need for clinical toxicology resources by emergency physicians is unclear and may have implications for future training and resource availability. This study was designed to assess current emergency physician use of available resources. DESIGN: Prospective evaluation by mail using a 49-item questionnaire. TYPE OF PARTICIPANTS: All 170 emergency physicians in Utah. INTERVENTIONS: None. RESULTS: The response rate was 75.3% (128 of 170). Resources "outside their own fund of knowledge" were consulted "occasionally" to "frequently" by 98.3%. They used the following resources "occasionally" to "frequently": poison control center (PCC) (93.7%), toxicology textbook (77.6%), "expert colleague" (34.0%), and "in-house POISINDEX" (23.9%). They often contacted the PCC for toxicity information (93.7%) and management recommendations (87.3%) and for acute, symptomatic overdose cases (88.3%). They "almost never" contacted the PCC for adverse drug reactions (76.6%), pill identification (70.2%), consultation with physician toxicologist (68.1%), asymptomatic exposures (62.9%), chronic toxicity (50.4%), or solely to report the case to the American Association of Poison Control Centers data base (90.2%). Those who had access to in-house POISINDEX often did not consult the PCC (82.6%). Of those who did not have in-house POISINDEX, 42.8% contacted the PCC to access it. Providing access to physician toxicologist consultations was thought to be an important role for the PCC by 86.7%, but only 32% of physicians were using this option. CONCLUSION: The vast majority of emergency physicians in Utah consult the PCC only for acute, symptomatic overdoses. They view access to physician toxicologist consultation as an important role for the PCC but seldom use it. The availability of in-house POISINDEX decreases the likelihood of PCC consultations from emergency departments. The frequency of emergency physician consultation with the PCC may decrease as POISINDEX becomes available at more hospitals.

Adult↗
PubMed1991

Demographic and electrocardiographic factors associated with severe tricyclic antidepressant toxicity.

This study was designed to evaluate a historic cohort of pure tricyclic antidepressant overdose patients for factors associated with severe toxicity. Hospitalized tricyclic antidepressant overdose patients were identified by computerized discharge diagnosis (ICD-9 codes). Patients with a serum drug screen positive for tricyclic antidepressants and an emergency department 12-lead electrocardiogram were included in the study. Multiple drug overdoses were excluded. Patients were divided into two groups: minor toxicity (n = 41 and major toxicity (n = 65). Criteria for inclusion in the major toxicity group were the occurrence of seizures, endotracheal intubation, coma, arrhythmias requiring treatment, hypotension, or death. The following were found to be associated with increased likelihood of major toxicity (p less than 0.05): ingestion of amitriptyline (odds ratio (OR) 2.57), age greater than or equal to 30 years (OR 2.56), heart rate greater than or equal to 120 bpm (OR 2.86), serum tricyclic antidepressant level greater than or equal to 800 ng/mL (OR 5.20), terminal 40 ms QRS axis (T40-ms axis) greater than or equal to 135 degrees (OR 2.73), QRS interval greater than or equal to 100 ms (OR 2.74), QRS axis greater than 90 degrees (OR 3.68), and QTc interval greater than 480 ms (OR 3.89). The mean T40-ms axis on the initial ECG was more rightward in the major toxicity group (174 +/- 84 vs 125 +/- 91 degrees, p = 0.006). We conclude that patients with severe tricyclic antidepressant toxicity tended to have a more rightward T40-ms axis than those with minor toxicity and that the presence of the above parameters was associated with an increased likelihood of severe toxicity.

Adult↗
PubMed1989

Terminal 40-ms frontal plane QRS axis as a marker for tricyclic antidepressant overdose.

Tricyclic antidepressant (TCA) poisoning has been reported to cause a right-axis deviation of 130 degrees to 270 degrees in the terminal 40-ms frontal plane QRS axis (T40-ms axis) of the ECG. This retrospective cohort study was designed to determine if the T40-ms axis could discriminate TCA-toxic patients from other overdose patients and whether a correlation exists between TCA plasma concentration and T40-ms axis rotation. Only symptomatic overdose patients with plasma and urine drug screens and an ECG obtained within two hours of each other were included in the study. Patients were divided into two groups: TCA overdose patients (TCA OD, n = 48) and nonTCA overdose patients (nonTCA OD, n = 30). The mean T40-ms axis was significantly more rightward in the TCA OD group compared with the nonTCA OD group (179 +/- 74 vs 86 +/- 87, P less than .001). A TCA OD patient was 8.6 times more likely to have a T40-ms axis of more than 120 degrees than was a nonTCA OD patient (odds ratio, 8.6; 95% confidence interval, 2.7 to 29.1). Eight of the TCA poisoned patients (17%) did not demonstrate a T40-ms axis between 120 degrees and 270 degrees. Receiver operating characteristics demonstrated that the T40-ms axis was a better indicator of TCA toxicity than the QRS interval (P less than .05). A T40-ms axis of 120 degrees or more was 83% sensitive and 63% specific for TCA overdose. A correlation between plasma TCA concentration and T40-ms axis deviation was not found (r = .04).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗