Intoxikace blokátory kalciových kanálů nejsou i přes jejich široké využití časté, ale jsou závažné a mají vysokou smrtnost. Při každé intoxikaci by se mělo pátrat po příčině, aby se zabránilo jejímu opakování. To je mimořádně významné u požití léků v suicidálním úmyslu. Projevem otravy bývá nejčastěji hypotenze, často doprovázená i hyperglykemií. Ovlivnění srdeční frekvence závisí na konkrétní léčivé látce a požité dávce. V léčbě se k pacientovi přistupuje individuálně podle závažnosti intoxikace, klinického stavu a komorbidit – od observace a střevní dekontaminace, přes specifickou terapii – podávání kalcia a inzulinu až po přístupy vyhrazené pro nejzávažnější stavy, jako je podpora vazopresory a připojení na ECMO.
Calcium channel blocker intoxications are not common despite their widespread use, but are often severe and have a high mortality. In any intoxication, the cause should be investigated to prevent recurrence. This is particularly relevant for suicidal intent. Hypotension is the most common manifestation of poisoning, often accompanied by hyperglycaemia. The effect on heart rate depends on the specific drug and the dose ingested. The treatment is individually tailored according to the severity of intoxication, clinical condition and comorbidities - from observation and intestinal decontamination, through specific therapy - calcium and insulin administration to approaches reserved for the most serious conditions such as vasopressors administration and ECMO theraphy.
- MeSH
- blokátory kalciových kanálů * otrava MeSH
- lidé MeSH
- otrava diagnóza etiologie farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Vitamín B17, známý také jako amygdalin, je přírodní kyanogenní glykosid dostupný jako potravinový doplněk, který je využíván v alternativní medicíně. Amygdalin se v těle hydroxyluje na toxický kyanid, který může způsobit život ohrožující intoxikaci. V kazuistice je prezentována život ohrožující otrava kyanidem po požití potravinového doplňku obsahující amygdalin, která byla úspěšně léčena hydroxocobalaminem. Kazuistika dále obsahuje management přednemocniční neodkladné péče u pacienta s akutní intoxikací.
Vitamin B17, well known as amygdalin, is originally a natural cyanogenic glycoside available as a dietary supplement used in the alternative treatment. Amygdalin hydroxylates to toxic cyanide in the body, which can cause life-threatening intoxication. The case report presents a life-threatening cyanide poisoning after ingesting a dietary supplement containing amygdalin identified in pre-hospital care, which was successfully treated with hydroxocobalamin. The case report also contains the management of pre-hospital care in a patient with acute intoxication.
- MeSH
- amygdalin * aplikace a dávkování metabolismus otrava MeSH
- hydroxokobalamin aplikace a dávkování MeSH
- kyanidy otrava MeSH
- lidé MeSH
- nádory komplikace terapie MeSH
- otrava * diagnóza farmakoterapie patologie terapie MeSH
- potravní doplňky otrava MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
In this paper, the potential antidote efficacy of commercially available formulations of various feed additives such as Minazel-Plus®, Mycosorb®, and Mycofix® was considered by recording their incidence on general health, body weight, and food and water intake, as well as through histopathology and semiquantitative analysis of gastric alterations in Wistar rats treated with the T-2 toxin in a single-dose regimen of 1.67 mg/kg p.o. (1 LD50) for 4 weeks. As an organic adsorbent, Mycosorb® successfully antagonized acute lethal incidence of the T-2 toxin (protective index (PI) = 2.25; p < 0.05 vs. T-2 toxin), and had adverse effects on body weight gain as well as food and water intake during the research (p < 0.001). However, the protective efficacy of the other two food additives was significantly lower (p < 0.05). Treatment with Mycosorb® significantly reduced the severity of gastric damage, which was not the case when the other two adsorbents were used. Our results suggest that Mycosorb® is a much better adsorbent for preventing the adverse impact of the T-2 toxin as well as its toxic metabolites compared with Minazel-plus® or Mycofix-plus®, and it almost completely suppresses its acute toxic effects and cytotoxic potential on the gastric epithelial, glandular, and vascular endothelial cells.
- MeSH
- adsorpce MeSH
- antidota chemie farmakologie MeSH
- časové faktory MeSH
- cévní endotel účinky léků patologie MeSH
- jodofory farmakologie MeSH
- LD50 MeSH
- molekulární struktura MeSH
- otrava farmakoterapie patologie MeSH
- potkani Wistar MeSH
- potravinářské přísady chemie farmakologie MeSH
- T-2 toxin otrava MeSH
- vztahy mezi strukturou a aktivitou MeSH
- žaludeční sliznice účinky léků patologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- MeSH
- acidóza laktátová chemicky indukované diagnóza terapie MeSH
- alkoholy škodlivé účinky MeSH
- Amanita patogenita MeSH
- biologické toxiny škodlivé účinky MeSH
- chronická renální insuficience chemicky indukované terapie MeSH
- dialýza ledvin MeSH
- diferenciální diagnóza MeSH
- kardiovaskulární látky škodlivé účinky MeSH
- komorbidita MeSH
- lidé MeSH
- metformin škodlivé účinky MeSH
- otrava * diagnóza farmakoterapie klasifikace patologie terapie MeSH
- oxid uhelnatý škodlivé účinky MeSH
- paracetamol metabolismus škodlivé účinky MeSH
- poruchy vědomí etiologie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- akutní nemoc * MeSH
- antidota klasifikace terapeutické užití MeSH
- diferenciální diagnóza MeSH
- dřevěné a živočišné uhlí terapeutické užití MeSH
- hypotermie * diagnóza patologie terapie MeSH
- lidé MeSH
- otrava * diagnóza farmakoterapie klasifikace terapie MeSH
- poranění elektrickým proudem * diagnóza terapie MeSH
- úpal * diagnóza patologie terapie MeSH
- úžeh patologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: During an outbreak of mass methanol poisoning in the Czech Republic in 2012-2014, we compared the total hospital costs and one-year medical costs in the patients treated with different antidotes (fomepizole versus ethanol) and modalities of hemodialysis (intermittent hemodialysis, IHD, versus continuous renal replacement therapy, CRRT). METHODS: Cross-sectional study in 106 patients with confirmed diagnosis treated in 30 ICU settings. For each patient, the following data were analyzed: admission laboratory data, GCS, PSS, ICU length of stay, organ failures, treatment, outcome, and total hospital costs. Of 83 survivors, in 54 (65%) patients the follow-up examination, quality of life measurement with SF36 questionnaire two years after discharge, and one-year medical costs analysis were performed. RESULTS: The median total hospital costs were 7200 (IQR 1500-10,900) euros and the median one-year medical costs were 1447 (IQR 133-1163) euros in the study population. The total hospital costs were higher in the patients treated with fomepizole comparing to ethanol: 12,890 (IQR 6910-16,210) versus 5590 (IQR 1430-6940) euros (p<0.001). The hospital costs in the patients treated with IHD were 5400 (IQR 1520-6910) versus 12,410 (IQR 5380-16,960) euros in the patients with CRRT (p=0.317). The geometric mean ratio for increased hospital costs in the patients treated with fomepizole versus ethanol adjusted for the severity of poisoning was 3.30 (1.70-3.80 CI 95%), p<0.001, and in the patients treated with IHD versus CRRT - 0.70 (0.60-0.99 CI 95%), p=0.047. The patients with visual sequelae had higher total hospital costs than those without sequelae: 10,419 (IQR 2984-14,355) versus 4605 (IQR 1303-4505) euros (p=0.009). The patients with GCS≤13 on admission had higher one-year medical costs as well (p<0.001). No difference was found in physical and mental condition scores in the patients treated with different antidotes and modalities of hemodialysis two years after discharge (both p>0.05). CONCLUSION: The total hospital costs in the patients with acute methanol poisoning were more than three times higher in the patients treated with fomepizole than in the patients treated with ethanol after adjustment for the severity of poisoning. The dialysis modality did not affect the total hospital costs, but the trend to lower costs was present in IHD-group.
- MeSH
- alkoholismus MeSH
- analýza nákladů a výnosů * MeSH
- antidota terapeutické užití MeSH
- dialýza ledvin MeSH
- dospělí MeSH
- ekonomika nemocniční MeSH
- epidemický výskyt choroby MeSH
- ethanol terapeutické užití MeSH
- hospitalizace MeSH
- kvalita života * MeSH
- lidé středního věku MeSH
- lidé MeSH
- methanol otrava MeSH
- náklady na zdravotní péči MeSH
- nemocnice - náklady * MeSH
- otrava farmakoterapie ekonomika MeSH
- prospektivní studie MeSH
- průřezové studie MeSH
- pyrazoly terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika MeSH
CONTEXT: The role of neuroinflammation in methanol-induced toxic brain damage has not been studied. OBJECTIVE: We studied acute concentrations and the dynamics of leukotrienes (LT) in serum in hospitalized patients with acute methanol poisoning and in survivors. METHODS: Series of acute cysteinyl-LT and LTB4 concentration measurements were performed in 28/101 hospitalized patients (mean observation time: 88 ± 20 h). In 36 survivors, control LT measurements were performed 2 years after discharge. RESULTS: The acute maximum (Cmax) LT concentrations were higher than concentrations in survivors: Cmax for LTC4 was 80.7 ± 5.6 versus 47.9 ± 4.5 pg/mL; for LTD4, 51.0 ± 6.6 versus 23.1 ± 2.1 pg/mL; for LTE4, 64.2 ± 6.0 versus 26.2 ± 3.9 pg/mL; for LTB4, 59.8 ± 6.2 versus 27.2 ± 1.4 pg/mL (all p < 0.001). The patients who survived had higher LT concentrations than those who died (all p < 0.01). Among survivors, patients with CNS sequelae had lower LTE4 and LTB4 than did those without sequelae (both p < 0.05). The LT concentrations increased at a rate of 0.4-0.5 pg/mL/h and peaked 4-5 days after admission. The patients with better outcomes had higher cys-LTs (all p < 0.01) and LTB4 (p < 0.05). More severely poisoned patients had lower acute LT concentrations than those with minor acidemia. The follow-up LT concentrations in survivors with and without CNS sequelae did not differ (all p > 0.05). The mean decrease in LT concentration was 30.9 ± 9.0 pg/mL for LTC4, 26.3 ± 8.6 pg/mL for LTD4, 37.3 ± 6.4 pg/mL for LTE4, and 32.0 ± 8.8 pg/mL for LTB4. CONCLUSIONS: Our findings suggest that leukotriene-mediated neuroinflammation may play an important role in the mechanisms of toxic brain damage in acute methanol poisoning in humans. Acute elevation of LT concentrations was moderate, transitory, and was not followed by chronic neuroinflammation in survivors.
- MeSH
- akutní nemoc MeSH
- cystein krev MeSH
- ethanol krev MeSH
- formiáty krev MeSH
- hospitalizace MeSH
- hydrogenuhličitany krev MeSH
- koncentrace vodíkových iontů MeSH
- kreatinin krev MeSH
- krevní glukóza metabolismus MeSH
- laktáty krev MeSH
- leukotrieny krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- methanol krev otrava MeSH
- mozek účinky léků patologie MeSH
- následné studie MeSH
- neurodegenerativní nemoci chemicky indukované patologie MeSH
- otrava krev farmakoterapie MeSH
- výsledek terapie MeSH
- zánět chemicky indukované patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The potency of the bispyridinium non-oxime compound MB327 [1,1'-(propane-1,3-diyl)bis(4-tert-butylpyridinium) diiodide] to increase the therapeutic efficacy of the standard antidotal treatment (atropine in combination with an oxime) of acute poisoning with organophosphorus nerve agents was studied in vivo. The therapeutic efficacy of atropine alone - or atropine in combination with an oxime, MB327, or both an oxime and MB237 - was evaluated by the determination of LD50 values of several nerve agents (tabun, sarin and soman) in mice with and without treatment. The addition of MB327 increased the therapeutic efficacy of atropine alone, and atropine in combination with an oxime, against all three nerve agents, although differences in the LD50 values only reached statistical significance for sarin. In conclusion, the addition of the compound MB327 to the standard antidotal treatment of acute poisonings with nerve agents was beneficial regardless of the chemical structure of the nerve agent, although at the dose employed, MB327 in combination with atropine, or atropine and an oxime, provided only a modest increase in protection ratio. These results from mice, and previous ones from guinea-pigs, provide consistent evidence for additional, albeit modest, efficacy resulting from the inclusion of the antinicotinic compound MB327 in standard antidotal therapy. Given the typically steep probit slope for the dose-lethality relationship for nerve agents, such modest increases in protection ratio could provide significant survival benefit.
- MeSH
- antidota aplikace a dávkování terapeutické užití toxicita MeSH
- atropin aplikace a dávkování terapeutické užití toxicita MeSH
- inbrední kmeny myší MeSH
- kombinovaná farmakoterapie MeSH
- LD50 MeSH
- molekulární struktura MeSH
- nervová bojová látka otrava MeSH
- otrava farmakoterapie MeSH
- oximy aplikace a dávkování terapeutické užití toxicita MeSH
- pyridinové sloučeniny aplikace a dávkování chemická syntéza terapeutické užití toxicita MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH