Symptoms Of Overdose Research Articles

A Case of Delayed and Persistent Carbamazepine Overdose Treated With Hemodialysis, Plasmapheresis, and Neostigmine.

Carbamazepine is utilized for various indications. Due to its pharmacokinetic profile and drug properties, toxicity can be delayed and persistent despite supportive care. We report a severe case of intentional carbamazepine toxicity in a carbamazepine naive individual mimicking brain death that was not diagnosed until three days after consumption of carbamazepine when the patient was comatose. Symptoms of overdose persisted for several days despite attempted treatment with activated charcoal and whole bowel irrigation, hemodialysis, and plasmapheresis. Symptoms only began to improve with bowel evacuation as a result of administration of neostigmine intravenously plus hemodialysis and plasmapheresis additionally. Despite previous literature that reported success with hemodialysis and/or plasmapheresis we did not find either to be overly effective in our case possibly due to lack of ability to perform multidose activated charcoal and whole bowel irrigation. To our knowledge this is one of the few cases of carbamazepine overdose utilizing both hemodialysis and plasmapheresis but without activated charcoal and the only case report in which neostigmine was administered as an attempt to remove drug via the gastrointestinal tract with success.

Potentially Life-Threatening Interaction between Opioids and Intrathecal Baclofen in Individuals with a Childhood-Onset Neurological Disorder: A Case Series and Review of the Literature.

Spasticity and dystonia are movement impairments that can occur in childhood-onset neurological disorders. Severely affected individuals can be treated with intrathecal baclofen (ITB). Concomitant use of ITB and opioids has been associated with central nervous system (CNS) depression. This study aims to describe the clinical management of this interaction, based on a case series and review of literature. Four individuals with childhood-onset CNS disorders (age 8-24) and CNS-depressant overdose symptoms after the concomitant use of ITB and opioids are described. The Drug Interaction Probability Scale (DIPS) was calculated to assess the cause-relationship (doubtful <2, possible 2-4, probable 5-8, and highly probable >8) of the potential drug-drug interaction. A literature review of similar previously reported cases and the possible pharmacological mechanisms of opioid-baclofen interaction is provided. After ITB and opioid co-administration, three out of four patients had decreased consciousness, and three developed respiratory depression. DIPS scores indicated a possible cause-relationship in one patient (DIPS: 4) and a probable cause-relationship in the others (DIPS: 6, 6, and 8). Discontinuation or adjusting ITB or opioid dosages resulted in clinical recovery. All patients recovered completely. In the literature, two articles describing nine unique cases were found. Although the opioid-ITB interaction is incompletely understood, concomitant use may enhance the risk of symptoms of CNS-depressant overdose, which are potentially life-threatening. If concomitant use is desirable, we strongly recommend to closely monitor these patients to detect interaction symptoms early. Awareness and monitoring of the potential opioid-ITB interaction is essential to reduce the risk of severe complications.

Opioid Misuse Harm Reduction.

The misuse of opioids by the public is a major health issue. Prescription opioids and nonprescription opioids, such as heroin and opium, are misused in epidemic proportions. When opioids are used incorrectly or illegally, they can lead to drug dependence, addiction, morbidity, and mortality. This program is in collaboration with the Jolt Foundation that provides resources to prevent opioid overdose deaths. This program involves community education on the dangers of opioid use and training on the use of naloxone rescue procedures to prevent overdose deaths. A pretest-posttest design was employed to determine if participants gained knowledge regarding the naloxone administration procedures. The researcher presented 10 community naloxone trainings that included staff from 20 different social service agencies, two schools, and three local churches. Each agency received at least one naloxone kit. The outcomes were met and included educating 137 participants on the risk factors and signs and symptoms of opioid overdose and the proper procedure to administer naloxone. One hundred twenty-eight posttests were returned and showed that the objectives for the project were met. The overall mean score for the pretests was 65.00 ( n = 126) with a standard deviation of 19.01, and the overall mean for the posttests was 86.64 ( n = 128) with a standard deviation of 14.60. Community social service agency staff were successfully educated to respond appropriately to overdose situations in a group training setting as evidenced by significant posttest scores.

Acute effects of fentanyl on carotid body sensory activity

Opioid drugs have long served as important agents for pain management in the clinic, but misuse of opioids, especially of illicit ultra-potent synthetic opioids like fentanyl, is driving the growing opioid epidemic. Like the natural opioid morphine, fentanyl targets μ-opioid receptor signaling in the central nervous system. However, the pharmacology of fentanyl on the opioid receptors differs from morphine, and clinical symptoms of fentanyl overdose like opioid-induced respiratory depression (OIRD) are more severe and less well-managed by reversal agents like naloxone. Hypoventilation due to OIRD stimulate peripheral chemoreceptors like the carotid body (CB). Previous reports suggest that morphine has minor effects on CB sensory output or the hypoxic ventilatory response mediated by the CB in animal models. Denervation of the CB significantly attenuates the hypoxic ventilatory response of unaesthetized rats after morphine treatment, suggesting that CB sensory activity persists in the presence of morphine to defend against OIRD. However, the effect of fentanyl on CB sensory responses has been little explored. Our goal was to determine how fentanyl regulates CB activity at the level of glomus cells, neuroendocrine sensory cells in the CB that signal to afferent nerves that project to the brainstem to increase ventilation. Sensory stimuli like hypoxia induce calcium transients in glomus cells across all species studied, including human. By two-photon imaging, we performed calcium imaging of mouse glomus cells expressing the genetically encoded calcium indicator GCaMP3 in intact CBs. Whereas morphine suppresses the activity of neurons in the central nervous system, application of fentanyl at levels sufficient to induce OIRD in mice acutely increased calcium transients in CB glomus cells. This increase in intracellular calcium was suppressed by naloxone, indicating that the stimulatory effect of fentanyl was mediated through opioid receptor signaling. In addition, we tested if glomus cells could respond to sensory stimuli in the presence of fentanyl. We found that the combination of fentanyl and hypoxia (PO2~25 mmHg) increased calcium responses over either fentanyl or hypoxia alone. These results suggest that CB stimulation through sensory pathways could potentially be targeted to increase ventilation in OIRD. Experimental groups contained 22-73 cells from least two preparations from different animals, and p&lt;0.05 was set as a significant difference using appropriate statistical test. This work is funded by a UCSF Innovation Ventures Catalyst Grant and NIH Grant R41DA056270. AJC is a co-founder of Olfa Thera, Inc. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Prevalence of Iatrogenic Vitamin D Toxicity Among the Saudi Population of Vitamin D Users Due to Overcorrection.

Background Despite abundant sunlight exposure, vitamin D deficiency remains a major challenge in Saudi Arabia. Meanwhile, the widespread use of vitamin D supplements has prompted concerns about toxicity, which although rare, can have severe health consequences. Objective The objective of this cross-sectional study was to analyze the prevalence and associated factors of iatrogenic vitamin D toxicity among the Saudi population of vitamin D users due to overcorrection. Methods An online questionnaire was used to collect data from 1,677 participants across all regions of Saudi Arabia. The questionnaire included responses on the prescription, duration of vitamin D intake, dosage, frequency, history of vitamin D toxicity, symptom onset, and duration. Results One thousand six hundred and seventy-seven responses were included across all regions of Saudi Arabia. A majority of participants were female (66.7%) and around half were aged 18-25 years. A history of vitamin D use was reported by 63.8% of participants, and 48% were still using vitamin D supplements. Most participants (79.3%) consulted a physician, and 84.8% had taken a vitamin D test before using the supplement. Commonly reported motives for taking vitamin D included vitamin D deficiency (72.1%), lack of sun exposure (26.1%), and hair loss (20.6%). Symptoms of overdose were reported by 6.6% of participants, with 3.3% having an overdose and 2.1% experiencing both overdose and symptoms. Conclusion This study showed that although a large portion of the Saudi population is taking vitamin D supplements, the prevalence of vitamin D toxicity is relatively low. However, this prevalence should not be ignored, and further research is needed to understand the factors contributing to vitamin D toxicity in order to minimize its occurrence.

Cases Report of a Medication Error by Look-a-Like Packaging: Metoclopramide and Paracetamol Suppositories

Medication errors are Unlike adverse drug reactions (ADRs) or adverse drug events (ADEs); mistakes by healthcare personnel cause them. We reported two cases of developed symptoms of Metoclopramide over-dose. Metoclopramide was given as Paracetamol due to look-a-like packaging. In Emergency Departments, reviewing the patient’s medications to prevent look-a-like complications should be done for all patients with suspected drug toxicity.

Quercetin: A Molecule of Great Biochemical and Clinical Value and Its Beneficial Effect on Diabetes and Cancer.

Quercetin belongs to the broader category of polyphenols. It is found, in particular, among the flavonols, and along with kaempferol, myricetin and isorhamnetin, it is recognized as a foreign substance after ingestion in contrast to vitamins. Quercetin occurs mainly linked to sugars with the most common compounds being quercetin-3-O-glucoside or as an aglycone, especially in the plant population. The aim of this review is to present a recent bibliography on the mechanisms of quercetin absorption and metabolism, bioavailability, and antioxidant and the clinical effects in diabetes and cancer. The literature reports a positive effect of quercetin on oxidative stress, cancer, and the regulation of blood sugar levels. Moreover, research-administered drug dosages of up to 2000 mg per day showed mild to no symptoms of overdose. It should be noted that quercetin is no longer considered a carcinogenic substance. The daily intake of quercetin in the diet ranges 10 mg–500 mg, depending on the type of products consumed. This review highlights that quercetin is a valuable dietary antioxidant, although a specific daily recommended intake for this substance has not yet been determined and further studies are required to decide a beneficial concentration threshold.

Inappropriate use of ivermectin during the COVID-19 pandemic: primum non nocere!

Inappropriate use of ivermectin during the COVID-19 pandemic: primum non nocere!

Berberine Is a Promising Alkaloid to Attenuate Iron Toxicity Efficiently in Iron-Overloaded Mice

Iron toxicity in iron-overloaded conditions, including high iron diet and blood transfusion, causes deleterious effects on vital organs. There currently are a number of chemical chelators in clinics to reduce iron concentration, for example , deferoxamine and deferiprone, but these produce diverse side effects. Hence, the need for a safe and effective iron chelator is demanded. To evaluate rigorously the potential of berberine on iron chelation and its anti-oxidant effect, 30 mice were divided into 5 groups of 6. Except for the control group, other groups received iron sucrose 5 times a week for 4 successive weeks as an i.p injection. Afterward, either berberine or deferoxamine was injected for 1 month. The mice were then euthanized and liver, kidney and lungs were carefully removed for biochemical and pathological analysis. In comparison with the iron group with an extraordinary amount of iron deposits, berberine (20 mg/kg/day) dramatically reduced iron sedimentation in all tissues ( P &lt; 0.01). Moreover, berberine lowered clinical symptoms of iron overdose, including inflammation, fibrosis and tissue degeneration. In terms of the activity of antioxidant enzymes, catalase and superoxide dismutase, iron overdose greatly reduced their activity compared to the control group. Berberine progressively increased their activity in comparison with the controls by lowering oxidative conditions ( P &lt; 0.05). Iron overdose similarly increased lipid peroxidation by increasing the level of malondialdehyde. Berberine promptly suppressed lipid peroxidation in an efficient manner and reduced the level of malondialdehyde, a marker of lipid peroxidation in the tissues. Accordingly, berberine, as a natural antioxidant compound, could adequately serve as a substitute for chemical chelators with fewer side effects and comparable effectiveness.

Levothyroxine Overdose in a Toddler – A Case Report

Levothyroxine tablet overdose, can happen in children, because of unique physical nature of the tablet. Although it has a benign course, systemic symptoms of overdose may manifest in few children. This cannot be predicted based on dose consumed or by thyroid function tests. Propranolol and steroid can be used for systemic autonomic symptoms. Delayed manifestation of overdose may occur, which needs follow up. In this report, we present a toddler who had levothyroxine overdose and was managed with monitoring and follow up. Her hyperactivity was managed with oral triclofos. We would also like to emphasize that serial thyroid function tests are not needed in these children.

A Case Report on Chronic Digoxin Toxicity

Digitalis glycosides are among the oldest drugs used in cardiology. Nowadays, due to the limited indications for their use (advanced heart failure, usually concomitant with atrial fibrillation), cases of toxicity induced by this class of drugs are rarely observed. Digoxin produces a positive inotropic and bathmotropic effect on the heart, but has a negative chronotropic and dromotropic effect. Cardiac glycosides have a narrow therapeutic window, so digitalis treatment can easily lead to symptoms of overdose. In patients taking digoxin, the drug therapeutic level should be maintained at 1-2 ng/ml; the toxic effects occur at concentrations &gt; 2.8 ng/ml and are mainly related to disturbances of cardiac function and of the circulatory system, as well as gastrointestinal symptoms and CNS disturbances. Here, a 65-years-old patient who was hospitalized following chronic ingestion with acute renal impairment. In spite of rapidly applied gastric irrigation and administration of activated charcoal, the drug level in the patient’s blood was estimated at 8.5 ng/ml. During her stay on the ward, typical symptoms of severe toxicity were observed: from gastric symptoms (severe nausea, vomiting) to conduction disturbances. Type I, moitz type 1 and 2 AV blocks were detected, as well as some supraventricular extrasystoles. These conduction disorders required the use of temporary endocardial pacing. Due to the unavailability of specific antidotes (antidigitalis antibodies) and lack of efficient methods of extracorporeal elimination of the drug, symptomatic treatment comprising the correction of electrolyte disturbances and heart rate control remains the most effective. Bangladesh Heart Journal 2021; 36(2): 139-144

Recreational use of GHB and prescribed drugs: the challenge in forensic and clinical toxicology.

The dual nature and the double use of γ-hydroxybutyric acid (GHB) are the fundamentals of its spread as recreational drug. Endo-genously, GHB acts as inhibitory neurotransmitter while exogenously it is administered in the form of sodium oxybate to treat cataplexy and to menage alcohol withdrawal. Illicit GHB is extensively used along with prescribed drugs and drugs of abuse for its euphoric and anabolic effects. Since it has been used as incapacitating agent to perpetrate rapes and commit robberies, GHB represents a social and public health issues. The tight window of detectability in biological matrices and the difficultly to read symptoms of polydrug overdose represent the modern challenges in forensic and clinical toxicology.

Baclofen: Therapeutic and Toxic Mechanisms of Action (Review)

Baclofen is a muscle relaxant, which is a beta-p-chlorophenyl derivative of an inhibitory neurotransmitter GABA. This drug may have serious side effects and cause life-threatening conditions which may recellular receptors to clarify the pathogenesis of life-threatening conditions caused by poisoning with this drug. The search was done using the PubMed and Scopus databases, and the final selection of 82 sources was made based on the relevance to the topic of this review and the type of article. The review included both the results of randomized studies and individual reports. The review briefly discusses the history of baclofen synthesis and its application in clinical practice, indications for prescription, mechanism of action and the specific features of its metabolism, its effect on the CNS, signs and symptoms of withdrawal syndrome, overdose and acute poisoning, as well as the interaction of baclofen with other drugs. C onclusion. Multiple studies failed to make definite conclusions about mechanisms of baclofen toxicity. To completely reveal the pathogenesis of life-threatening conditions occurring due to baclofen use, further studies of molecular and cellular effects of this drug, as well as genetic factors controlling its metabolism, are warranted.

Comparison of the efficacy of an infusion pump or standard IV push injection to deliver naloxone in treatment of opioid toxicity

Background:The optimal goal of naloxone infusion in intensive care units is to ameliorate opioid-induced side effects in therapy or eliminate the symptoms of opioid toxicity in overdoses. Accurately monitoring and regulating the doses is critical to prevent adverse effects related to naloxone administration. The present study aimed to compare treatment outcomes when using two methods of intravenous naloxone infusion: an infusion pump or the standard method. Methods:This study involved 80 patients with signs and symptoms of opioid overdose. The patients were randomly assigned into two groups with respect to intravenous infusion of naloxone by either an infusion pump or the standard method. Results:Comparison of study parameters between the two groups at 12 and 24 hours after intervention showed significantly more compensatory acid-base imbalance in the naloxone infusion pump group. In the group that received naloxone by pump, only one patient experienced withdrawal symptoms, but withdrawal symptoms appeared in 12 patients (30.0%) in the standard intravenous infusion group within 12 hours and in seven additional patients (17.5%) within 24 hours of intervention. In the group receiving pump-based naloxone infusion therapy, no another complications were reported; however in the standard infusion group, the 12-hour and 24-hour complication rates were 55.0% and 32.5%, respectively. The length of hospital stay was 2.85±1.05 and 4.22±0.92 days for the pump and standard infusion groups, respectively (P<0.001). Conclusions:Naloxone infusion using an infusion pump may be safer with regard to hemodynamic stability, resulting in shorter hospitalization periods, and fewer posttreatment complications.

How to recognize caffeine overdose.

Caffeine is the most widely consumed stimulant in the world and can offer a variety of benefits when consumed in moderation. But consuming caffeine in extremely high amounts can lead to an overdose. This article examines how nurses can recognize the signs and symptoms of caffeine overdose and educate patients on how to prevent this common problem.

The rise of opioid overdose: Is availability of Naloxone within the community the answer we need?

Rates of substance use and overdose are continually on the rise within our communities. Recent events highlight the increase rate of opioid overdose in particular and reflect current trends of a two-fold increase in such an event. Opioids are problematic as they can be prescribed legally or gained illegally. Symptoms of opioid overdose can be reversed with the provision of naloxone. Rising prices for naloxone may prevent organizations from carrying large quantities of it, which is problematic given recent events. As there is no typical presentation of opioid addiction or those with concurrent mental health issues, the influence or effect of each on the individual and with each other should be examined in their entirety. Different types of treatment are examined, as well as several of the strengths and limitations of ea

Pharmaceutical opioid overdose deaths and the presence of witnesses

BackgroundIn the past two decades, rates of pharmaceutical opioid use and harms resulting from their use (including death) have risen. The present study identified a series of fatal opioid overdoses where there was evidence that witnesses had noted symptoms consistent with overdose, and examined associated contextual factors. MethodsA retrospective review was undertaken utilising the Coroners Court of Victoria’s Overdose Deaths Register for pharmaceutical opioid overdose deaths between 2011 and 2013. Information on the source of pharmaceutical opioids, co-contributing drugs, history of drug dependence, and mental illness was extracted and coded. ResultsPharmaceutical opioids were involved in 587 deaths, and within these, 125 cases (21%) were witnessed. The majority of these witnessed deaths (77.6%) occurred at the deceased’s residence, with the witness being a partner or unrelated acquaintance who did not realise the significance of what they were witnessing. The most common contributing pharmaceutical opioids were methadone (49.6%), codeine (32.0%), and oxycodone (19.2%), with the source more often prescribed than diverted. Co-contributing drugs were involved in 110 cases, with the most common being benzodiazepines. Evidence of current dependence and mental illness was found in 53.6% of cases. ConclusionMost pharmaceutical opioid overdose deaths with a witness present occurred in the deceased’s home, with symptoms of overdose being noted, but not acted upon. These findings support the trialling of education and/or naloxone to partners and family members of people who use pharmaceutical opioids in order to reduce overdose deaths.

Intrathecal Pump Refills, Pocket Fills, and Symptoms of Drug Overdose: A Prospective, Observational Study Comparing the Injected Drug Volume vs. the Drug Volume Effectively Measured Inside the Pump

One complication associated with the refill procedure of intrathecal drug delivery systems (IDDSs) include a "pocket fill," which is the inadvertent injection of the drug into the subcutaneous space surrounding the pump. The purpose of our study was to assess the mean volume discrepancy between the injected and the effective drug volume inside the IDDS reservoir after refills that did not lead to signs of overdose and to record at which volume discrepancy symptoms of overdose were noticed. After 221 refill procedures performed in 19 adult patients, drug volume inside the reservoir was assessed with a fill level sensor, and the volume discrepancy between injected and measured volume was recorded. Symptoms of overdose were monitored. For between group comparisons the Mann-Whitney U test was used, using a p-value of <0.05 to indicate statistical significance. The median volume discrepancy in the 20 mL IDDSs was 0.40 mL (IQR: 0.18-0.61; 10th p: 0.0; 90th p: 0.74) whereas in the 40 mL IDDSs the median volume discrepancy was 1.3 mL (IQR: 1.06-1.74; 10th p: 0.81; 90th p: 2.2). Symptoms of overdose were observed after 6 out of the 221 refill procedures. Volumes at which the symptoms of overdose arose were between 1.15 and 4.5 mL in 20 mL IDDSs and between 2.08 and 4.88 mL in 40 mL IDDSs. A volume discrepancy of >1 mL in 20 mL IDDSs and of >2 mL in 40 mL IDDSs after refill should be regarded as potentially consequential with regard to risk of overdose possibly caused by a pocket fill. In case of potentially consequential volume discrepancies, hospitalization and monitoring is recommended to preclude late overdose symptoms outside the hospital.

Opioid Substance Abuse Among Occupational Therapy Clients

ABSTRACTThis study examined opioid substance abuse among clients of occupational therapists. A sample of 500 occupational therapists, representing five targeted clinical practice areas, was randomly selected from American Occupational Therapy Association membership. Of these, a total of 182 participants ultimately responded to postal surveys. Results found one third considered opioid substance abuse a problem at their facility, and over half reported having one or more clients known to be or suspected of abusing opioids. Moreover, one in five reported having a client exhibit symptoms of overdose. Recommendations for a concerted response by the profession of occupational therapy to this nationwide epidemic are presented.

Marijuana Use in the Elderly: Implications and Considerations.

This article reviews the literature on the use of marijuana in the elderly. Pharmacists play an important role in the management of medications including drug use of potentially illegal drugs, including marijuana. The use of both recreational and medical marijuana has grown exponentially in the general population, including in older adults. As of 2017, marijuana for medical use is legal in 26 states and the District of Columbia. PubMed and Internet search using the following terms: marijuana, cannabis, delta-9-tetrhydrocannabinol (THC), cannabidiol, cannabinoid, elderly, geriatric, and pharmacology. Findings are based on data collected from older adults (65 years of age and older) through August 2016. Because of the lack of research and funding, reputable literature on the impact of marijuana on older adults is scarce. The available evidence suggests that elderly individuals should be cautious when consuming marijuana, especially those who have certain comorbid conditions. The geriatric population has a higher likelihood of having multiple comorbidities and is subject to polypharmacy. Marijuana use, medicinal or recreational, complicates the picture with additive central nervous system side effects. This article reviews the growing information on marijuana use and discusses issues to consider and cautions in usage that can apply to day-to-day clinical practice and geriatric care. The role of the pharmacist in educating patients, caregivers, and health care providers is expanding with the growing number of states that have legalized medical marijuana (26 states and the District of Columbia, as of 2017). Important education points including drug-drug interactions, drug-disease interactions, and signs and symptoms of acute overdose should be considered. With this review, pharmacists will be informed on recommendations on the use of marijuana in the older adult. Monitoring of therapy, as well as adverse effects, will be reviewed, including some legal issues and challenges.