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Biomedical subjects

F Paloucek

Publications and source records attributed to F Paloucek.

7 recordsLinked to original sources
PubMed1996

Late increase in acetaminophen concentration after overdose of Tylenol Extended Relief.

We report a case demonstrating a late increase in acetaminophen concentration after ingestion of Tylenol Extended Relief (extended-release acetaminophen; McNeil Consumer Products) along with drugs known to slow gastrointestinal motility. Coingestants that slow gastrointestinal motility are known to affect the interpretation of serum drug concentrations. However, this case illustrates potentially significant differences between extended-release and immediate-release acetaminophen and demonstrates an exception to the current manufacturer recommendation for the use of the Rumack-Matthew nomogram in this setting.

Acetaminophen↗
PubMed1994

Hypokalemia after pediatric albuterol overdose: a case series.

Sympathomimetic use results in a triad of hypokalemia, hyperglycemia, and elevated white blood cell count. Transient hypokalemia results from activation of the Na+/K+ pump and transport of potassium intracellularly. Increased serum glucose and insulin may also contribute to the intracellular shift of potassium after sympathomimetic use. Four cases of accidental pediatric albuterol ingestion with significant hypokalemia are reported. Four children between 1 and 6 years of age presented to the emergency department within 5 hours of ingesting 3.0, 1.1, 3.7, and 1.7 mg/kg albuterol, respectively. All four presented alert and oriented in no apparent distress. The most common findings were vomiting, sinus tachycardia, and hypokalemia (2.3, 2.5, 2.8, and 2.5 mmol/L, respectively). Each child received a single dose of activated charcoal and intravenous potassium replacement. All patients recovered uneventfully within 12 to 24 hours with supportive care only. These cases demonstrated that significant depressions in serum potassium can occur after pediatric albuterol overdose. Although transient, the dose-response relationship and duration of effect is unknown. Although significant hypokalemia can occur after ingestion of oral sympathomimetics, replacement should be managed on an individual basis until further studies are completed.

Acute Disease↗
PubMed1992

Reversal of ethanol-induced respiratory depression by flumazenil.

Flumazenil is effective in reversing sedation resulting from benzodiazepine (BZD) toxicity. Its use for other causes of sedation have not been well described. A 23-y-old male was found unconscious. Upon being aroused, the patient stated he had recently ingested 1 1/2 bottles of vodka/beer and 250 mg of diazepam. Physical examination revealed shallow breathing and respiratory depression. Arterial blood gases were consistent with the clinical diagnosis of respiratory depression (pH 7.34, pCO2 47, pO2 99). However, after receiving 3 mg of flumazenil, the respiratory depression improved so that the patient no longer required intubation. The drug screen returned negative for BZDs and the patient had a blood alcohol level of 332 mg/dl. He later denied BZD use. The patient's clinical course improved throughout the study period, and mechanical ventilation was avoided. This report reflects a possible role for flumazenil in reversing the respiratory depression produced by ethanol ingestion.

Adult↗
PubMed1990

Blood pressure decrease prior to initiating pharmacological therapy in nonemergent hypertension.

In order to characterize the decrease in blood pressure that occurs in the emergency department (ED) setting in cases of nonemergent hypertension before beginning pharmacological therapy, 94 consecutive cases of hypertension seen at the University of Illinois Hospital were reviewed. Each patient in the analysis had a triage blood pressure recorded by the nursing staff and second blood pressure reading taken between 10 minutes and 2 hours after the triage pressure before pharmacological therapy was begun. Patients with diastolic pressures less than 90 mm Hg were excluded, as were patients with acute end-organ pathology secondary to hypertension. In the remaining 54 cases, the mean arterial pressure fell by 6% (P less than .003), the systolic pressure fell by 6% (P less than .022), and the diastolic pressure fell by 6.4% (P less than .003), suggesting that in nonemergent hypertension, a significant decrease in blood pressure occurs in the ED before pharmacological therapy is begun. The blood pressure decrease was not statistically different when sex and age were considered, but when patients were grouped into those with diastolic pressures between 90 mm Hg and 114 mm Hg and those with diastolic pressures greater than or equal to 115 mm Hg, there was a statistically significant decrease in systolic, diastolic, and mean arterial pressures only in patients with diastolic pressures greater than or equal to 115 mm Hg. Our findings suggest that patients with nonemergent hypertension do not always require immediate and aggressive pharmacological intervention in the ED setting and are best observed for a short period and then reassessed before beginning pharmacological therapy.

Adult↗