Bupropion Overdose Complicated by Cardiogenic Shock Requiring Vasopressor Support and Lipid Emulsion Therapy

BackgroundBupropion overdose is a commonly encountered presentation in the emergency department (ED). While the majority of cases resolve with supportive care, serious adverse effects, including seizures, cardiogenic shock, and death, can occur. Intravenous lipid emulsion (ILE) therapy has been utilized for a multitude of poisonings with varying levels of success. Although a number of cases suggest the value of ILE therapy in cases of bupropion overdose, more recent data propose that its role may be overstated.Case ReportA young woman presented to the ED with altered mental status complicated by seizure after bupropion overdose. She subsequently developed cardiogenic shock requiring vasopressor support. Bedside echocardiogram revealed a decreased left ventricular ejection fraction (LVEF). She received ILE therapy with significant improvement in both hemodynamic status and LVEF by bedside ultrasound.Why Should an Emergency Physician Be Aware of This?Although the majority of patients presenting with bupropion overdose improve with supportive care, life-threatening sequelae are possible. ILE therapy has shown promise in a variety of different overdose situations, although the evidence in cases of bupropion poisoning has been varied, and it has traditionally been utilized as a last-line rescue modality. Based on hemodynamic parameters and bedside ultrasound, this case suggests that early initiation of ILE therapy should be considered in these cases, as the potential benefits likely outweigh the theoretical risks.     

Hepatic reticuloendothelial function during parenteral nutrition including an MCT/LCT or LCT emulsion after liver transplantation – a double-blind study

It has been demonstrated that total parenteral nutrition (TPN) modulates the function of the hepatic reticuloendothelial system (RES). The objective of this study was to evaluate the impact of two different TPN lipid emulsions on the recovery of allograft RES function after orthotopic liver transplantation (OLTx). In a prospective, double-blind study, OLTx patients were randomly assigned to two treatment groups. Group I ( n=13) received a TPN regimen that included long-chain triglycerides (LCT). Group II ( n=9) received a TPN regimen that included a fat emulsion consisting of both medium-chain triglycerides (MCT) and LCT. At baseline, i.e., on days 2 or 3 after OLTx ( t1), before lipids for TPN were started, hepatic RES function was determined using the human serum albumin millimicrosphere technique (K-value, 1/min). A second measurement ( t2) was obtained after 7 days of TPN, including one of the study's two fat emulsions. The mean (+/- SD) K-value (1/min) was 0.48+/-0.16 in the LCT group and 0.55+/-0.28 in the MCT/LCT group at t1, and it improved to 0.62+/-0.21 in the LCT group and to 0.86+/-0.32 in the MCT/LCT group at t2. RES function recovery was significantly better in the MCT/LCT group ( P< or = 0.05). MCT/LCT emulsion appears to be the TPN fat emulsion of choice after OLTx as it seems to have less impact on hepatic RES recovery.     

软质聚氨酯泡沫塑料用于植皮手术包扎的临床与实验研究

目的 通过临床与实验研究选择合适的皮片游离移植手术包扎材料.方法 实验分别以软质聚氨酯泡沫塑料、层叠干纱布、松散干沙团和干棉花团为测试包扎材料.分别在测试包扎材料上加压,记录血浆袋所受到的压力和包扎材料厚度压缩比例的变化;临床常规方法片皮移植,以软质聚氨酯泡沫塑料块加压包扎皮片.结果 软质聚氨酯泡沫塑料当外加压力使其压缩至原厚度的90%～34%时,可使皮片受到25 cmH2O～54.4 cmH2O的压力;此压力范围足以使皮片与创面密切接触,保证皮片成活,又避免过大的压力影响皮片血供重建.以软质聚氨酯泡沫塑料为包扎材料植皮,皮片成活率明显提高.结论 软质聚氨酯泡沫塑料是一种良好的植皮包装材料.     

液膜法提取发酵液中的苯丙氨酸 Ⅱ.操作工艺条件

从芫花Ｄａｐｈｎｅ ｇｅｎｋｗａ条的乙酸乙酯可溶部分分到３个结果性化合物，借助于波谱分析手段推断出Ⅱ为西瑞香素，Ⅲ为ｄａｐｈｎｏｄｏｒｉｎ Ｂ。     

溶剂在嵌段共聚高分子膜中的溶解与传递现象

利用石英弹簧称重法测定了308．15K时乙醇和苯在含端羟基聚丁二烯(HTPB)和端羟基聚丁二烯／丙烯腈共聚物(HTBN)的嵌段共聚聚氨酯膜中的吸收动力学曲线。结合吸收-络合吸附双模式传递模型，研究了聚氨酯膜的微相分离程度、软硬段的比例和组成以及软段分子量等因素对溶剂在膜中溶解和传递性质的影响。     

乳液聚合型品红成色剂的应用性能

测试了3种新型L-品红成色剂的应用性能。结果表明：与母体品红成色剂相比，L-品红成色剂能显著地减少在蓝光区的有害吸收；与工业用油溶性品红成色剂Ns相比，L-品红成色剂的一些照相性能更加优越。     

全营养素混合液(TNA)在肠外营养的应用

脂肪乳剂、葡萄糖、氨基酸、电解质、维生素及微量元素按一定程序混合配成10种全营养素混合液。在4℃14天贮存期内,10种混合液的pH和渗透压变化不大,不同混合液在不同时期的脂粒平均直径变化为0.3135±0.1012μm～0.4813±0.1893μm,94.93％脂粒的直径<0.6μm,无直径>6μm的脂粒,细菌培养阴性。74例共输全营养素混合液1,796次,无不良临床反应和异常实验室检查结果;用1周以上者大都显示氮平衡改善,用2周以上者血清转铁蛋白和白蛋白浓度可有不同程度升高。     

脂肪乳剂在重症急性胰腺炎营养治疗中的安全性及有效性分析

目的 :探讨脂肪乳剂应用于重症急性胰腺炎的安全性和有效性。　方法 :回顾分析重症急性胰腺炎病人肠外营养治疗期间 ,应用脂肪乳剂的影响。 74例重症急性胰腺炎病人行肠外营养治疗 ,按静脉营养液是否含脂肪乳剂分为脂乳组和非脂乳组。　结果 :脂乳组肠外营养治疗后清蛋白、前白蛋白改善显著 (P <0 .0 1 ) ,非脂乳组则无显著变化 (P >0 .0 5 ) ,脂乳组较非脂乳组改善明显 (P <0 .0 1 ) ;血清肌酐、尿素氮等在脂乳组治疗后下降明显 (P <0 .0 5 ) ,较非脂乳组改善显著 (P <0 .0 5 ) ;营养治疗结束后 ,脂乳组高血糖症状明显得到控制 (P <0 .0 1 ) ,而非脂乳组效果不佳 (P >0 .0 5 ) ,脂乳组优于非脂乳组 (P <0 .0 5 ) ;血淀粉酶均有下降 ,脂乳组未见异常增高。　结论 :重症急性胰腺炎病人输注脂肪乳剂安全有效 ,有助于恢复正氮平衡     

脂肪乳剂对健康人外周血单个核细胞磷脂脂肪酸组成的影响

目的探讨脂肪乳剂对健康人免疫细胞脂肪酸组成的影响。方法采用毛细管气相色谱法检测8名健康志愿者连续7天外周静脉输注脂肪乳剂(20%intralipid)后,外周血单个核细胞磷脂脂肪酸谱的变化。结果静脉输注脂肪乳剂对健康人外周血单个核细胞数量、肝功能和血脂无影响,软脂酸(C16∶0)、油酸(C18∶1N9)比例在单个核细胞磷脂酰乙醇胺(PE)中明显增加(P<0.05,P<0.01);硬脂酸(C18∶0)减少(P<0.05);亚麻酸(C18∶3N3)、软油酸(C16∶1N7)在磷脂酰胆碱(PC)中明显增加(P<0.05),而其余脂肪酸均未发生明显改变。饱和脂肪酸与不饱和脂肪酸的比值(S/U)和脂肪酸的不饱和指数(UI)在单个核细胞PE、PC中均保持不变。结论脂肪乳剂不可能通过影响免疫细胞磷脂脂肪酸组成的途径对免疫功能产生影响。     

聚氨酯避孕套临床前使用可行性和可接受性分析

目的 对使用新型聚氨酯(Pu)男用避孕套的可行性和可接受性进行初步观察。方法 对30对健康已婚夫妇为期6周360次使用国产PU避孕套的效果进行问卷调查。结果 避孕套总破裂率(临床破裂 非临床破裂)为2．22％，临床滑脱率为16．5％，使用观察期间无意外妊娠发生。结论 新型PU避孕套的破裂率和滑脱率分别相近于和高于报道的乳胶避孕套使用情况，感官指标反映PU避孕套具有良好的可接受性。