Prolonged delirium without anticholinergic signs following amitriptyline overdose.

In a case of acute intoxication with a tricyclic antidepressant (amitriptyline) delirium was prolonged without there being prominent peripheral anticholinergic or electrocardiographic signs. Administration of physostigmine, repeated when necessary, reversed the delirium.     

试论少阳病汗出而解

通过对<伤寒论>中少阳病禁汗与汗解的分析,认识了二者并不矛盾,少阳病汗出而解与其主方小柴胡汤作用趋势密切相关.在少阳病兼有太阳表证时,和解兼发汗是及时有效的方法.     

Cardiac complications following tricyclic antidepressant overdose. Issues for monitoring policy

Thousands of people in the United States poison themselves with tricyclic antidepressants each year. While these patients often require cardiac monitoring for potential arrhythmias, clinical practice is highly variable in regard to the hours of monitoring required. Clarification of this issue is important because of the impact on resources. This study retrospectively reviews the monitoring practices and cardiac complications following tricyclic antidepressant overdose in 75 adults. The patients received an average of 61.7 hours of monitoring. The vast majority of electrocardiographic changes, including three cardiac arrests, appeared within the first 24 hours. No patient with a normal level of consciousness and a normal electrocardiogram for 24 hours went on to develop any significant arrhythmia. On the basis of these data and an extensive literature review, we propose that current guidelines for cardiac monitoring following tricyclic antidepressant overdose be reconsidered.     

Intentional iron overdose: an institutional review.

OBJECTIVE: To document the frequency of admissions and the outcome of patients with a diagnosis of intentional iron overdose to a large urban hospital. DESIGN: Retrospective review of hospital records. SETTING: Health Sciences Centre, Winnipeg, an 1100-bed primary and tertiary care centre serving a regional population of about 1.2 million. PATIENTS: All patients with a discharge diagnosis of iron overdose who were admitted from Jan. 1, 1979, to July 1, 1991. Of these 113 cases 66 (58%) represented an intentional iron overdose on the basis of information derived from the patient, family or friends. MAIN OUTCOME MEASURES: Frequency of admissions, length of hospital stay and survival rate. RESULTS: Most (53 [80%]) of the 66 patients were females. The mean age was 19.8 (standard deviation [SD] 6.1) years (range 9 to 48 years). One third of the cases were associated with excess alcohol intake. The frequency of hospital admissions increased during the study period (1.4 cases per year in the first 5 years and 9.8 cases per year in the last 5; 5.3 cases per year overall). The mean length of hospital stay was 6.8 (SD 12.1) days, and the mortality rate was 10%. CONCLUSIONS: Hospital admissions because of intentional iron overdose are becoming more frequent in this centre and are associated with appreciable morbidity and mortality rates. Prospective studies are required to delineate clearly the signs, symptoms and abnormal laboratory findings associated with this problem.     

Baclofen overdose

A 57-year-old woman suffering from multiple sclerosis took an estimated 1500 mg of baclofen. She became deeply unconscious with generalized flaccid muscle paralysis and absent tendon reflexes. Toxicological analysis confirmed the presence of baclofen together with small amounts of paracetamol and glutethimide. Supportive therapy, including assisted ventilation for 3 days, led to complete recovery; anticonvulsant drugs were necessary for the treatment of grand mal fits. The clinical features and treatment of baclofen overdose are discussed.     

Recovery of adrenocortical function following treatment of tuberculous Addison's disease.

We report two cases of Addison''s disease occurring in association with proven Mycobacterium tuberculosis infection. Both were treated with modern chemotherapeutic agents and were shown to have developed normal adrenal cortical function after several years. We suggest that adrenal function should be tested after modern anti-tuberculous therapy of this disease.