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PubMed1995

The use of oxytocin.

Synthetic oxytocin offers a safe and effective means of producing regular uterine activity and has a fairly large therapeutic index; however, the mild antidiuretic and vasoactive properties of oxytocin increase the risk of water intoxication and hypotension. The issue of reduction in cesarean section rates through the use of an active management protocol is being studied actively in the United States and Canada at this time. The authors recommend infusion protocols for the augmentation and induction of labor that use low doses of dilute oxytocin, increased at intervals no more than 40 minutes. Pharmacokinetic and clinical studies support the use of oxytocin in the physiologic range as efficacious and prudent. The longer induction to delivery time demonstrated by some, but not all authors, in our opinion, is a reasonable alternative to avoidable uterine hyperstimulation with the potential for fetal and maternal injury. We advocate the use of the lowest dose necessary to produce adequate uterine contractility and cervical change.

Birth Injuries↗

PubMed1977

Psychotic pica, nicotinism, and complicated myocardial infarction.

The authors report a case of a schizophrenic patient who repeatedly consumed a wide variety of inedible materials, including significant quantities of tobacco. The phenomenology of this behavior, as well as its psychiatric and medical complications are discussed. It is probable that chronic nicotinism contributed to this patient's refractoriness to psychiatric treatment and to his eventual cardiovascular crisis. The occurrence of pica as a manifestation of severe psychopathology was vividly described by the early pioneers of neuropsychiatry, but has received little attention in recent psychiatric literature. This is in marked contrast to the syndrome of psychogenic water intoxication which continues to be reported frequently. The majority of descriptions of pica have dealt with its occurrence in children, in pregnant women, and as a societal practice in certain cultures studied from a medico-anthropologic point of view. The toxic organic brain syndrome caused by chronic ingestion of nicotine-containing products has also been neglected in psychiatric publications. Descriptions of the neuropsychiatric complications of subacute and chronic nicotinism have been restricted to textbooks of toxicology, where greater emphasis has been given to the acute effects of large quantities of nicotine, often in forms other than tobacco. The following case illustrates the near-fatal practice of tobacco pica in a psychotic patient and dramatically demonstrates the systemic and central nervous system effects of nicotinism.

Adult↗

PubMed1976

Decreased antidiuretic response in diabetes insipidus during prolonged treatment with carbamazepine presumably due to enzym-induction.

Carbamazepine (CA)-induced antidiuresis and fluorescence in urinary cortisol assay was compared during short-term and prolonged treatment in 3 patients with pituitary diabetes insipidus. The fluorescence induced by excreted CA-metabolite(s) (probably CA-10-11 epoxide and its derivatives) was used for the rough clinical estimation of the rate of metabolic elimination of the drug. A marked decrease was observed both in the antidiuretic response induced by CA and excretion of CA metabolite(s) during prolonged treatment - with a fixed dose of CA. These findings suggest that diminishing antidiuretic effectiveness might be due to auto-induction of CA. Auto-induction of CA may explain the delay in improvement of renal concentrating operation in patients with DI during long-term treatment with fixed doses of CA. Another clinical consequence of this mechanism may be the prevention of the development of water intoxication in neuro-psychiatric patients undergoing chronic treatment with CA.

Carbamazepine↗

PubMed1964