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Biomedical subjects

R J Roberge

Publications and source records attributed to R J Roberge.

At least 37 records · Page 2Linked to original sources
PubMed1998

Putaminal infarct in methanol intoxication: case report and role of brain imaging studies.

Methanol toxicity can cause severe central nervous system insult in which a characteristic pattern of bilateral putaminal injury is noted on brain imaging studies. We present a fatal case of subacute methanol toxicity with associated diffuse brain involvement, including bilateral putaminal necrosis and cerebral edema with ventricular compression. Theoretical basal ganglia toxicologic mechanisms of methanol poisoning are reviewed, and the role of brain imaging studies will regard to diagnosis, prognosis and impact on management is discussed.

Adult↗
PubMed1997

"Cloniderm" toxicity: another manifestation of clonidine overdose.

We present a case of accidental transdermal clonidine toxicity in a six-year-old child who was applying a clonidine patch intermittently to her dermis in the mistaken assumption that it was an adhesive bandage. Although the child appeared to be drug toxic, she repeatedly denied ingestion of any substances to family, paramedics, and hospital staff but was not initially questioned regarding dermal exposure. In dealing with drug toxic states in which the differential diagnosis includes drugs available as transdermal delivery systems, the evaluation should include questions regarding possible dermal exposure and a thorough skin examination.

Administration, Cutaneous↗
PubMed1994

Ceramic lead glaze ingestions in nursing home residents with dementia.

Three cases of acute lead ceramic glaze ingestions that occurred in elderly patients during art therapy classes in nursing homes are reported. Initial blood lead levels were 109 micrograms/dL (5.23 mumol/L), 259 micrograms/dL (10.43 mumol/L), and 85 micrograms/dL (4.08 mumol/L), respectively, and all patients underwent chelation therapy. Two individuals tolerated therapy well and showed no discernable changes from baseline state. One patient with a lead encephalopathy died and is, to the best of our knowledge, the first report of a death directly related to a ceramic lead glaze ingestion. Ceramic lead glaze ingestions among institutionalized patients may be more common than generally appreciated and occasionally are associated with significant morbidity or, rarely, mortality. Simple preventive measures could eliminate the majority of such occurrences.

Acute Disease↗
PubMed1994

Mixed fluoxetine/loxapine overdose and atrial flutter.

A 19-year-old man who attempted suicide by ingesting approximately 600 mg fluoxetine (Prozac) and 140 mg loxapine (Loxitane) had two episodes of atrial flutter shortly thereafter. Admission serum fluoxetine, norfluoxetine, and loxapine levels were 1,053 ng/mL, 702 ng/mL, and 40 ng/mL, respectively. This case of atrial flutter in association with an overdose of either of these drugs demonstrates the potential for cardiotoxicity with these agents in the overdose setting. Theoretical mechanisms of cardiotoxicity are presented.

Adult↗
PubMed1994

Supraventricular tachyarrhythmia associated with baclofen overdose.

Baclofen overdose occasionally results in cardiac effects, but serious tachyarrhythmias have not been reported. We present the case of a 21-year-old man with an acute baclofen overdose who developed increased cardiac conduction times and a rapid supraventricular tachyarrhythmia which required medical intervention. Acute baclofen toxicity can result in the development of tachyarrhythmias and cardiac monitoring is warranted in acute overdose states.

Adenosine↗
PubMed1993

Intentional massive insulin overdose: recognition and management.

A case of intentional massive insulin overdose requiring prolonged glycemic support is presented. Suicidal insulin overdose may be more common than generally appreciated. Because hypoglycemic reactions are evaluated routinely in the ED, emergency physicians should maintain a high degree of suspicion regarding suicidal intent or foul play in diabetics with hypoglycemia who respond minimally to the administration of concentrated glucose solutions or in hypoglycemic presentations by nondiabetics who have access to diabetic medications. Fingerstick glucose evaluations or serum glucose levels should be obtained routinely at 15 to 30 minutes after glucose administration in any hypoglycemic patient to gauge the intensity of glucose use. Inability to maintain euglycemia following glucose administration suggests excessive insulin and requires further workup. Evaluation of serum insulin and C-peptide levels is useful in confirming intentional overdoses in cases that are not clear-cut. Glucose infusion rates must be tailored individually to each overdose situation as great individual variability exists in insulin absorption and effects. The clinician should anticipate the possible need for prolonged glycemic support in this setting.

Adult↗
PubMed1993

Use of sodium polystyrene sulfonate in a lithium overdose.

A 23-year-old woman with an acute-on-chronic lithium overdose received multiple oral doses of sodium polystyrene sulfonate totaling 150 g over a 24-hour period. During the 33 hours after the institution of therapy, the serum lithium level decreased from 4.20 to 0.68 mEq/L. The calculated serum lithium elimination half-life of 12 hours is significantly shorter than that previously noted in other similar overdoses, and the patient suffered no adverse effects of therapy. Multiple-dose sodium polystyrene sulfonate may be useful in lowering the serum lithium level of select patients with acute lithium overdoses but is not a substitute for hemodialysis in severely ill patients.

Acute Disease↗
PubMed1993

Cervical spine radiography after blunt trauma. Is it always needed?

In trauma cases, the mere presence of a cervical immobilization device is not an indication for radiography of the cervical spine. High-yield radiographic criteria have been prospectively determined for cases of blunt trauma, and these identify individuals at low risk for cervical spine injuries. Cervical spine radiography is not required for patients who are alert, cooperative, and nonintoxicated and do not have neurologic deficits, cervical signs or symptoms, antecedent spinal mobility disorders, or distracting injuries. Cervical spine radiography alone does not ensure detection of all injuries. Adequate history taking and careful examination are always essential and may dictate additional studies.

Cervical Vertebrae↗
PubMed1992

Whole bowel irrigation in an acute oral lead intoxication.

An 89-year-old man acutely ingested approximately three ounces of a ceramic glaze preparation with a 30% lead oxide content. A blood lead level of 18 micrograms/mL was reported from a sample drawn within 1 hour of ingestion and just prior to gastric lavage. Following lavage, an abdominal radiograph demonstrated lead throughout the small intestine. Whole bowel irrigation was then undertaken and subsequent x-rays demonstrated clearing of all lead in the small bowel. At 16 and 24 hours post-ingestion, blood lead levels rose to 39 micrograms/dL and 42 micrograms/dL, respectively, and the patient then underwent a 5-day course of chelation therapy. This is the first reported case of the use of whole bowel irrigation in an acute lead ingestion. The use of decontamination techniques in acute lead ingestions is reviewed.

Administration, Oral↗
PubMed1991

Cat-scratch disease.

Cat-scratch disease is a relatively common disorder that is the result of infection with a recently identified gram-negative bacillus. Although it is overwhelmingly a benign, self-limited illness requiring only supportive care, serious complications can occur and the disease may be life-threatening on occasion. Although randomized clinical trials of antibiotic therapy for CSD do not exist, CSD has demonstrated in vitro susceptibility to several antibiotics, and gentamicin has been reported beneficial in a few patients with systemic manifestations of the illness. Therefore, pending clinical trials, gentamicin may be worthy of consideration in CSD patients with serious manifestations of this illness. CSD is one of the most common causes of adenopathy and should be considered in all patients who present with unilateral or regional lymphadenopathy.

Cat-Scratch Disease↗
PubMed1991

Facilitating cervical spine radiography in blunt trauma.

The interpretation of cervical spine radiographs is an important facet of the evaluation of blunt trauma victims. The diagnostic accuracy of cervical spine films is dependent upon the technical adequacy of the radiographs and the clinician's diagnostic and interpretive skills. The anxiety inherent in cervical radiographic interpretation by the nonradiologist can be minimized by coupling the use of several simple techniques aimed at enhancing visualization of all cervical spine elements and optimizing bony definitions with an unhurried, methodical radiographic evaluation utilizing a number of radiologic "pearls" in those instances in which injury is less than readily apparent but still suspect.

Cervical Vertebrae↗
PubMed1989

Glossal abscess.

A 21-year-old man presented to our emergency department with a two-day complaint of painful swelling and protrusion of the tongue, odynophagia, dysphagia, and difficulty with speech. A nonfluctuant area of tongue swelling was identified; needle aspiration of this site produced 5 mL of pus, with considerable amelioration of symptoms. Culture of the aspirate subsequently grew Hemophilus parainfluenzae, the first such reported case of this pathogen in a glossal abscess. Glossal abscess is a rare clinical entity that may result in airway compromise and disseminated infection to other systems. The presence of a glossal abscess should be considered in all cases of tongue swelling.

Abscess↗