Biomedical subjects
Publications and source records attributed to K Saxena.
Isoniazid (INH) is the cause of one of the most common serious drug overdoses and can cause severe metabolic acidosis. We report a case of INH overdose that is most notable because the patient survived without apparent sequelae after experiencing an extremely low pH level (6.49). This is the lowest reported pH level with patient survival. Toxicity and pharmacology of INH and various aspects of metabolic acidosis are discussed.
Management of inflicted or self-inflicted trauma to accomplish homicide or suicide is no novelty in the practice of medicine. However, it takes an astute clinician to recognize serious poisoning in the midst of life-threatening injuries. We describe two cases where homicide and suicide attempts were accompanied with the ingestion of methanol. Both patients recovered with proper management of the injuries as well as early recognition and treatment of the methanol poisoning.
We report two cases of cyanide poisoning from accidental ingestion of an imported metal cleaning solution used by some Southeast Asians for shining coins. Both patients received specific therapy and recovered completely after a dramatic sequence of sudden collapse and severe cardiovascular compromise.
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The main aim of the present study was to evaluate the neurochemical changes in the levels of gangliosides, total lipids, phospholipids, cholesterol, esterified fatty acids and triglyceride of the hypothalamus, hippocampus, amygdaloid nucleus, midline nuclei of thalamus, gyrus cinguli and olfactory bulbs following the intramuscular administration of ethinylestradiol (100 mcg) to each female rabbit daily for 30 days. Remarkable increment in the concentration of gangliosides was discernible in hippocampus, amygdaloid nucleus and olfactory bulbs. Interestingly, these levels showed significant decrement in the hypothalamus. The contents of total lipids, triglyceride and esterified fatty acids exhibited significant decrease in the hypothalamus. On the other hand, these levels showed a remarkable increment in olfactory bulbs with a significant elevation in the levels of phospholipids. The concentration of phospholipids was, however, markedly depleted in amygdaloid nucleus. The contents of esterified fatty acids exhibited decrement in hippocampus but the midline nuclei of thalamus showed increment. A significant elevation was also discernible in the levels of triglyceride in gyrus cinguli. The results suggest that the lipid contents are affected differentially in the various parts of the brain.
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Nicotine is a toxic substance which is readily available from a wide variety of sources. Due to the universal availability of nicotine, the primary care physician may encounter accidental or deliberate poisoning in a variety of clinical settings and should be familiar with diagnosis and management of nicotine toxicity. We report a case in which a depressed patient attempted suicide using nicotine extracted from snuff as a lethal drug. Three other cases illustrating the effects and clinical management of nicotine poisoning are also reviewed. The etiology, diagnosis and management of nicotine overdose are discussed.
Presented is the case of a 55-year-old alcoholic with an inferior glenohumeral dislocation of his right shoulder. The patient was unable to move his right arm, which was flexed at the elbow and locked in an overhead position. After roentgenographic confirmation of the dislocation, traction-counter-traction was employed for reduction. Reduction was indicated by an audible click. The shoulder was immobilized and the patient was discharged for follow up in two weeks. Luxatio erecta is the result of a severe hyperabduction mechanism frequently associated with significant rotator cuff injury. Immediate reduction followed by surgical repair of the rotator cuff at a later date is the standard treatment.
Trazodone did not appear to be a potent respiratory depressant or cardiotoxic or neurotoxic agent in our cases. Further experience is needed to determine a recommended treatment procedure. It is not clear whether the experience with these two cases can be extrapolated to elderly patients, patients with serious physical illnesses, or cases involving larger ingestions. Additional information is required concerning concurrent ingestion of trazodone and alcohol or other CNS-depressant drugs. It would appear that standard treatment including emptying of the stomach, activated charcoal and cathartic, and close observation to monitor and support the respiratory and cardiovascular systems is appropriate. These two case reports suggest that trazodone lacks the serious toxicity encountered with other antidepressant compounds when taken in large overdoses.
Management of the acutely poisoned patient should start with decontamination of the skin and irrigation of the eyes, if necessary, and assessment of cardiorespiratory status, neurologic status, and pupils and eye movement. If a definable toxic syndrome is present, the specific "antidote" should be given. If no such syndrome is apparent and the patient is comatose, 50 ml of 50% glucose and 0.4 mg of naloxone (Narcan) intravenously should be tried. General measures, applicable in either situation, include induction of emesis or lavage and administration of charcoal and cathartics.
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Foetal remnants were found in uterine curettings obtained from three women complaining of irregular vaginal bleeding. These findings are discussed in relation to other cases in the literature in which heterotopic tissues have been found in curettings and also for the light they throw on the origin of the so-called uterine teratomas.
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