Management Of Overdose Research Articles

Management of drug overdose with haemodialysis and haemoperfusion

Management of drug overdose with haemodialysis and haemoperfusion

Monitoring and interpretation of antidepressant plasma concentrations.

A brief review of the factors influencing plasma tricyclic concentrations and the relationship between clinical response and plasma concentration is presented. It is concluded that routine monitoring of tricyclics is unwarranted. In some specific instances monitoring tricyclic antidepressant plasma concentrations may be indicated: in cases of therapeutic failure a low level may indicate poor compliance or rapid metabolism and the need to increase the dose; for the management of side effects, especially when cardiac abnormalities exist prior to therapy; in cases of polypharmacy when drug interactions can occur; the management of overdoses and in patients with physical illnesses especially renal and hepatic disease. The elderly also constitute a group of patients in whom drug monitoring may be advisable. This group of patients tends to develop higher plasma levels than younger patients on equivalent doses. Some guidelines for the interpretation of laboratory results are presented and discussed.

The intoxication with cyclizin in infancy and adult age (Experiences of a contamination-information-central office) (author's transl)

Epidemiological, clinical and therapeutic aspects obtained from 38 cases of intoxication with the antiemetic drug "cyclizine" in children and adults are discussed. The relative frequency of accidentally or purposely performed overdosage shows a decreasing tendency. The introduction of regulations after the prescription of cyclizine compounds, leaving a limited dose available without prescription and the introduction of a safety package to prohibit misuse by children are reported in their relationship with the epidemiologic data. A toxic dose of 5 mg/kg body weight, a minimal lethal dose (MLD) of about 80 mg/kg are evaluated and compared with previous published data. Differences of age in the development of the clinical picture of the cyclizine-intoxication with a disposition for the evolvement of convulsions in children compared to the total lack of convulsions in adults have to be pointed out. The management of overdoses follows general principles of treatment like gastric lavage, supporting care and includes the specific treatment with the antidote "physostigmin-salicylate", which causes a shortening of the time of recovery.

The acute management of intrathecal methotrexate overdose: Pharmacologic rationale and guidelines

INTRATHECAL METHOTREXATE TtlERAPY is now used widely for the prevention and treatment of meningeal leukemia and lymphoma. During the past year we have been consulted on more cases Of intrathecal methotrexate overdosage then in any previous year. In the study reported here we used a modified one-compartment pharmacologic model to suggest guidelines for the acute management of intrathecal methotrexate poisoning, and illustrate how the approach was applied to two patients. METHODS AND PHARMACOLOGIC RATIONALE A modified Single compartment model was used to predict the efficacy of cerebrospinal fluid withdrawal for removal of intrathecally administered drug. The compartment was takefi to represent the volume of drug distribution within the CSF (Vi,Cs~). As such, VJ s~ was not held constant but expressed as a function of time (t) after administration. This modification incorporates the ascent of drug in the subarachnoid space after intralumbar administration. The initial VD csF was taken as the volume of drug injected (Vo). The rate of V~ csF expansion during the initial phase or distribution was assumed tO be governed by CSF bulk flow. The latter was approximated by the rate of CSF production which in the model was assumed to be 30 ml/hour? Hence,

365 ANALYSIS OF DRUG PRESCRIBING INFORMATION FOR PEDIA-TRICS AND OBSTETRICS AS PRESENTED IN THE PHYSICIANS DESK REFERENCE

In order to assess the impact of the recent upsurge in pediatric drug research, the 1980 edition of the Physicians Desk Reference was reviewed for data and indications pertaining to pediatric and obstetric usage. A total of 1.133 entries were reviewed. Of these 71.9% were oral preparations, 20% parenteral, 1.6% various other routes of administration and 6.5% included multiple routes. Dosing data based on weight or surface area was provided in 27.8% of entries. Specific pediatric dosing data was provided in 40.9% of entries while pediatric usage was specifically contraindicated in 8.9% of entries. In 39.1% of entries no mention was made of pediatric usage and in 11.1% it was mentioned, but without clear recommendations or data. In 2.6% of entries use in pregnancy was approved while 10.3% contained a definite contraindication for such use. The remaining entries either failed to mention use in pregnancy (31.8%) or mentioned use in pregnancy but without definite recommendation (55.3%). Use in breast feeding mothers was mentioned in 27.9% of entries with data provided in 107 entries and a definite contraindication in 104. Data on overdose management was provided in 29.8% of entries. Marked variability was noted between drug classes and manufacturers in terms of the information provided. It is clear from the above analysis that a continued emphasis is needed by manufacturers on providing solid data pertaining to drug usage in pediatrics and obstetrics.

Panel discussion. Management of acetaminophen overdose.

Dr Winchester : One of the controversial issues that came out in the article of Dr Meredith and his colleagues is the delay of vomiting and symptoms in the cases reported to the National Poison Information Service (NPIS) of Great Britain. I would like to ask Dr Meredith and the panel, in general, first, whether there has been any defect in the reporting by physicians in your survey and, second, whether there is any evidence that the combination tablets have an antiemetic effect? More than half of your patients who reported had taken a combination tablet. Dr Meredith : I think the reporting is reliable. Nevertheless, it is possible that some of the more subtle symptoms are missing. For this reason, we attempted to corroborate the more indirect findings of the NPIS by including figures from the Analgesic Overdose Survey in which patients were admitted to hospitals that had a special interest

Extracorporeal treatment of salicylate or acetaminophen poisoning--is there a role?

Hemodialysis or sorbent hemoperfusion has been used in the management of clinical overdose of salicylates or acetaminophen. Hemodialysis offers considerable benefit in severe salicylate poisoning and is preferred to hemoperfusion or peritoneal dialysis, since it more rapidly corrects acid-base and electrolyte abnormalities than does hemoperfusion, and since it is clearly more efficient than is peritoneal dialysis for the removal of salicylates. Charcoal hemoperfusion in animal studies and hemodialysis in man have been shown to accelerate acetaminophen elimination from the body. Hemodialysis and hemoperfusion are of questionable benefit in clinical acetaminophen overdose. However, our clinical experience to date with charcoal hemoperfusion in "late" acetaminophen overdose has been associated with a less notable increase in liver enzyme concentrations in comparison with results of retrospective studies of series of patients treated or not treated with sulfhydryl donors.

An innovative audit of overdose management in a general hospital.

Back to table of contents Previous article Next article ArticleNo AccessAN INNOVATIVE AUDIT OF OVERDOSE MANAGEMENT IN A GENERAL HOSPITALJoseph C. Borchulte, and Marjorie W. ShannonJoseph C. BorchulteSearch for more papers by this author, and Marjorie W. ShannonSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.32.1.61AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "AN INNOVATIVE AUDIT OF OVERDOSE MANAGEMENT IN A GENERAL HOSPITAL." Psychiatric Services, 32(1), pp. 61–62 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 32Issue 1 January 1981Pages 61-62 Metrics PDF download History Published online 1 April 2006 Published in print 1 January 1981

Hemodialysis of mefenamic acid in uremic patients

The effect of hemodialysis on plasma mefenamic acid levels was studied in four patients on long-term hemodialysis. A 500-mg oral dose of mefenamic acid was administered to the fasting patients two hours before hemodialysis. Arterial and venous blood samples taken before dialysis, at 30-minute intervals during a three-hour dialysis, and immediately before termination of dialysis were assayed by high-performance liquid chromatography. Mefenamic acid half-life on hemodialysis was not reduced substantially compared with that reported for normal patients. The extraction efficiency of the hollow-fiber kidneys averaged 6.4%. The mean drug recovery was 1.03 mg or 0.2% of the administered dose. The extensive plasma protein binding (range: 85-97%) accounted for the poor recovery. The study suggests that adjustment of mefenamic acid dosage is not necessary in patients undergoing hemodialysis and that hemodialysis is of minimal value in the management of mefenamate overdose.

Hemodialyzability of acetazolamide.

Because the dialyzability of acetazolamide is not known, we undertook a study to determine the in vivo dialysance of this drug and found it to average 22 ml per minute. The quantity of the drug removed by four hours of dialysis was approximately 30% of the dose administered intravenously one half hour before dialysis. Accordingly, considerable amounts of the drug are removed by dialysis, despite its high intraerythrocytic distribution and plasma protein binding properties. Therefore, hemodialysis may be effective in the management of acetazolamide overdose, particularly when complicated by the presence of renal failure. The dialysance can vary under different dialyzing conditions. An acetazolamide/urea nitrogen extraction ratio of 0.16 established in this study can be used to predict the acetazolamide dialysance in various dialyzing conditions.

A compendium of antidepressants.

This compendium provides a quick reference to available tricyclic antidepressants, monoamine oxidase inhibitors, lithium carbonate, and stimulants. The charts include adult dosages, drug precautions, side effects, interactions with other drugs, and effects on clinical laboratory tests. Basic information on the prevention and management of overdose with these agents is also covered. Although the guide alone is no substitute for a thorough review, it can serve as a reminder of how these drugs are used in various clinical settings and of the problems associated with their use.

Fixed-Bed Charcoal Hemoperfusion

Fixed-bed activated charcoal cartridges were used for hemoperfusion in the treatment of 54 patients with overdose of one or more drugs, including barbiturate, glutethimide, ethchloryvnol, meprobamate, methyprylon, methaqualone, salicylate, and diazepam. The most dramatic improvement was noticed in patients with phenobarbitol intoxication; they were admitted in stage 3-4 coma and were either awake or arousable by verbal communication at the end of 1 1/2 to 3 1/2 hours of hemoperfusion. Other intoxications improved slowly and required longer duration of treatment. The clearance rates of the drugs with hemoperfusion were greater than those usually achieved with hemodialysis. The data demonstrate the efficacy and usefulness of charcoal hemoperfusion for the management of drug overdose.

Furosemide-Induced Forced Diuresis in Digoxin Intoxication

In three cases of attempted suicide by massive digoxin ingestion, a therapeutic attempt was undertaken to shorten the duration of toxicity of the drug by accelerating the removal of the glycoside from the body. Early administration of intravenous (IV) furosemide and fluids appeared to increase digoxin excretion in one case, which resulted in a substantially shortened digoxin half-time of eight hours. In two cases this therapy, initiated after a delay of 12 and eight hours was ineffective. The half-times were 51 and 43 hours, respectively. At an early preequilibrium stage, higher serum-tissue ratios of digoxin are present; thus, greater amounts of free digoxin are available for glomerular filtration and excretion. The prompt treatment by IV furosemide may be beneficial in the management of massive digitalis overdose.

The effects of naloxone and picrotoxin on the sedative and anticonflict effects of benzodiazepines

Interactions between naloxone and the benzodiazepine, chlordiazepoxide (CDP), were investigated in rats in a Conditioned Suppression of Drinking Test (CSD), which is a model of experimental conflict behavior. Naloxone reversed the anticonflict activity of CDP in this test. Naloxone and picrotoxin were then tested against CDP in rats using the Geller Conflict Test, which is an operant model of conflict behavior. Both naloxone and picrotoxin antagonized the anticonflict effects of CDP. Naloxone and picrotoxin were also tested for their abilities to reverse CDP-induced loss of righting reflexes in mice. Both naloxone and picrotoxin antagonized the loss of righting reflexes induced by CDP. Naloxone had no effect on the loss of righting reflexes induced by barbiturates or meprobamate. These results suggest that naloxone may be useful in the management of benzodiazepine overdoses.

Guide to management of drug overdose.

Guide to management of drug overdose.

Psychotropic Drugs: A Manual for Emergency Management of Overdose.

Psychotropic Drugs: A Manual for Emergency Management of Overdose.

The Management of Barbiturate Overdose in Non‐specialized Units

The Management of Barbiturate Overdose in Non‐specialized Units