Acute Alcohol Intoxication in Adolescents: Frequency of Respiratory Depression

Background

Adolescents and young adults are frequent users of alcohol. Younger patients may be more sensitive to the effects of alcohol than their adult counterparts, and toxicity has been known to occur at lower doses. Respiratory depression is a serious adverse effect of alcohol intoxication; however, current monitoring practices may not adequately detect respiratory depression.

Objective

Our objective was to determine the frequency of hypoventilation as measured by capnography among adolescents with acute alcohol intoxication. Our secondary objective was to determine if an association exists between alcohol levels and incidence of hypoventilation.

Methods

This was a prospective observational pilot study of patients 14–20 years of age with acute alcohol intoxication. Blood or breath alcohol measurements were obtained on arrival. Hourly measurements of vital signs including capnography were recorded.

Results

Sixty-five subjects were analyzed. Mean alcohol level was 185 mg/dL. Twenty-eight percent of subjects had episodes of hypoventilation. Episodes occurred in similar proportions on arrival and during the first 5 h of measurements. There was no difference in alcohol levels between subjects who did and did not hypoventilate (185 mg/dL vs. 186 mg/dL; 95% confidence interval −29 to 25). Oxygen desaturations occurred in 14 subjects and were associated with hypoventilation (p = 0.015).

Conclusions

Hypoventilation is common among adolescents who are acutely intoxicated with alcohol. It is independent of alcohol level and occurs at a steady rate during the first several hours of intoxication. Capnography should be considered as an additional monitoring device to detect these episodes and enhance patient safety.     

Lung Compliance Following Cardiac Arrest

Objective: To determine lung compliance in patients who had out-of-hospital cardiac arrests.
Methods: A prospective, observational study of patients suffering nontraumatic cardiopulmonary arrest and requiring CPR at one university hospital ED. Following termination of resuscitation efforts, lung compliance was measured. Measurements were made while inflating the lung from 250 mL to 2.000 mL (in 250-mL increments) using a calibrated supersyringe. Airway flow and pressure were measured at the endotracheal tube with a pneumotachograph and a pressure transducer. Flow and pressure signals were recorded by a respiratory monitor and used to construct pressure-volume curves for calculation of lung compliance.
Results: The 25 cardiac arrest patients (17 men, eight women) had a mean (± SD) age of 65 ± 7 years. Mean lung compliance was 0.051 ± 0.011 L/cm H₂O. Lung compliance was smaller at low lung volumes, suggesting the presence of alveolar collapse. Compliance values from 500 mL to 1,500 mL were similar. Compliance also diminished with increasing duration of CPR.
Conclusions: One previous publication suggested that lung compliance following resuscitation is 0.022 L/cm H₂O. The results of this study, using the accepted standard measurements of static lung compliance, suggest that true compliance is twice this value. This finding has important ramifications for future research on ventilation during resuscitation and current ventilation standards.     

Acute Barium Intoxication and Hemodiafiltration

We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.     

Recurrent Classic Migraine Attacks Following Transdermal Scopolamine Intoxication

A 20 year old male naval crew-member suffering from sea sickness was treated with transdermal scopolamine (TS). After 5 months of continuous treatment, he developed scopolamine intoxication followed by the appearance of recurrent classic migraine attacks. He had never suffered from headache or migraine prior to TS intoxication. The migraine attacks comprised a prodrome of apathy, bad mood and loss of appetite lasting several hours. An aura of scintillating spots, left arm numbness and paresthesias lasting several minutes was followed by a severe throbbing unilateral headache with photophobia, sonophobia and nausea. After one year of repeated follow-up examination, he continued to suffer from the attacks once every 10 to 14 days, with no identified precipitating factors. We are not aware of similar cases in the medical literature. Although it is not possible to establish TS intoxication as a causal effect of the appearance of classic migraine in our patient, the temporal association and clinical course are very supportive of this assumption. Central nervous system neurotransmitter imbalance of cardiovascular alterations may possibly be implicated.     

各种急性中毒650例临床分析

目的:为探讨急诊收治各种急性中毒病人防治策略提供更为详尽的科学依据.方法:收集2006年1月～2007年1月就诊于我院急诊科的650例急性中毒的临床资料,对其性别、年龄、中毒种类及途径、临床表现、就诊方式、转归及死因、救治方法等8项内容进行统计分析.结果:本组男289例,女361例,男女性别比为1:1.2;中毒年龄主要集中在18～40岁(85.1%);中毒种类依次是酒精中毒242例(37.2%),药物中毒184例(28.1%),一氧化碳中毒106倒(16.1%);最常见的中毒途径依然是消化遗和呼吸道;中毒原因以自杀(63.2%)为主;并发症的发生率为18.4%,病死率为2.46%.结论:本组资料为急性中毒的抢救、防范及发展趋势的研究提供了有价值的信息.     

Death Due to Acute Salicylate Intoxication Despite Dialysis

Background: Salicylate poisoning is a common problem with appreciable morbidity and mortality. We present a case of a patient with a large aspirin ingestion who expired despite aggressive hemodialysis (HD). Case Report: A 35-year-old man arrived at the Emergency Department 7.5 h after ingesting 400 tablets of 325-mg aspirin. He was afebrile, the respiratory rate (RR) was 30 breaths/min, heart rate (HR) 120 beats/min, blood pressure (BP) 125/76 mm Hg, and oxygen saturation 99% on room air. His salicylate concentration was 89.6 mg/dL. His initial arterial blood gas: pH 7.48, pCO₂ 21 mm Hg, PaO₂ 97 mm Hg, and bicarbonate 15.8 mmol/L. His initial serum chemistry panel was normal. He received activated charcoal and intravenous hydration with sodium bicarbonate. Two hours after arrival, salicylate concentration was 91.6 mg/dL. The patient became agitated and HD was initiated; 22 h after presentation, repeat salicylate concentration was 88.4 mg/dL and his creatinine was 3.9 mg/dL. A second run of HD was performed. After this, his temperature had risen to 39.06°C (102.3°F), BP 122/64 mm Hg, HR 168 beats/min, RR 43 breaths/min, and oxygen saturation 95% (2 L nasal cannula). His confusion increased, and he died 40 h after his ingestion. Conclusion: HD is widely advocated in managing severe salicylate intoxications, however, no consensus exists for the duration and best mode of therapy. Patients with severe salicylate poisonings may require extended durations of HD to effectively mitigate toxicity. Additional study is warranted to determine optimal therapy in severe salicylate intoxications.     

急性溴苯睛中毒患者的护理

本文总结了7例溴苯腈中毒患者的护理。认为给患者迅速有效地供氧,轻症患者给予中高流量鼻导管给氧、重症患者必要时给予高压氧舱治疗,抽搐时保持呼吸道通畅,及时吸痰。用特效解毒剂亚硝酸钠、硫代硫酸钠治疗时应严密观察患者的血压等情况,高热患者应给予物理降温和药物降温,加强心理护理和对工人的健康教育,密切监护病情变化,对病情稳定的患者也不能掉以轻心。     

Intoxication with Taxus Baccata: Cardiac Arrhythmias Following Yew Leaves Ingestion

WILLAERT, W., et al. : Intoxication with Taxus Baccata: Cardiac Arrhythmias Following Yew Leaves In-gestion. The use of yew leaves (Taxus Baccata) as a means of deliberate self-harm is infrequent. The potent effect of the toxin is primarily cardiac and results in rhythm alterations and ultimately ventricular fibrillation. As there is no known antidote, and classic antiarrhythmic therapy proves to be ineffective, a prompt diagnosis is of great importance as immediate supportive action is the only valuable alternative. This case describes a 43-year-old women who attempted suicide by ingesting the leaves of Taxus Baccata. We discuss the effects and the difficulty of treatment associated with yew leaf poisoning.     

严重急性呼吸综合征(非典型肺炎)

严重急性呼吸综合征 (SevereAcuteRespiratorySyndrome,简称SARS ,我国称之为传染性非典型肺炎 ,简称非典 )是 2 0 0 3年 2月首先在我国广东省报告 (后追溯到首例于 2 0 0 2年 1 1月 1 6日在该省佛山市出现 ) ,随后在许多国家和地区流行 ,目前已引起国际普遍关注的一种严重的肺炎。SARS可以引起高热、严重的呼吸障碍、类似流感样全身症状 ,目前在我国病死率 6%左右。截止2 0 0 3年 5月 31日 ,全球已有 32个国家或地区报告了 8360例SARS可能病例 (我国称临床诊断病例 ) ,其中我国内地报告数占 63 7% ,同时报告死亡 764例〔1〕。截止到…