Serotonin syndrome is a potentially fatal condition caused by drugs that affect serotonin metabolism or act as serotonin receptor agonists. Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors are the medications most commonly associated with serotonin syndrome. Serotonin syndrome can be mild and of short duration, but a prolonged course, life-threatening complications, and death are possible. Detection of serotonin syndrome is not difficult if the diagnostic criteria are understood and properly used, but the syndrome has no confirmatory tests and other drug-induced syndromes can, to a degree, mimic serotonin syndrome. The treatment is symptomatic and supportive. Antidotal therapies are available, but the evidence for their effectiveness is limited. If serotonin syndrome is promptly identified and aggressively treated, the patient should fully recover.

SynopsisThe mechanical properties of binary blends of high-density polyethylene and polypropylene are quite good compared to those for blends of some other immiscible pairs. The property relationships observed depend strongly on the process used to fabricate the blends as shown by comparisons of specimens made by injection and compression molding with widely varied cooling rates in the latter. Strength and modulus may show additive behavior or have positive or negative deviations, depending on the process conditions; however, measures of ductility like impact strength or elongation at break always show negative departures from additivity and exhibit minima in some cases. Addition of an appropriate ethylene-propylene elastomer greatly improves the ductility of these blends but with a corresponding decrease in strength and modulus. The presence of weld lines has a serious detrimental effect on mechanical properties of these blends.

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Overdoses of b-blockers and calcium channel blockers can produce significant morbidity and mortality, and conventional therapies often do not work as treatments for these poisonings. High-dose insulin/glucose therapy has been successful in reversing the cardiotoxic effects of these drugs in cases where the standard therapies have failed, and it appears to be relatively safe. Many successes have been well documented, but the clinical experience consists of case reports, the mechanisms of action are not completely understood, and guidelines for use of the therapy are empirically derived and not standardized. Regardless of these limitations, high-dose insulin/glucose therapy can be effective, it is often recommended by clinical toxicologists and poison control centers, and critical care nurses should be familiar with when and how the therapy is used. b-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/ Glucose Therapy H igh-dose insulin/glucose therapy, which is also called hyperinsulinemic/euglycemic therapy or insulin-dextrose therapy, has received considerable attention as a treatment for overdoses of b-blockers and calcium channel blockers that are refractory to conventional therapies. Clinical experience using high-dose insulin/glucose to treat cardiotoxic poisonings in humans dates to 1999, 1 and animal experiments before that time provided the theoretical background and the impetus for extension of its use to treat calcium channel blocker overdoses and then b-blocker overdoses.Despite many articles in medical publications and 15 years of clinical experience with its use, questions remain about how high-dose insulin/glucose therapy works and when and for whom this therapy should be applied. In addition, the dosing guidelines are not standardized. However, high-dose insulin/ glucose therapy is commonly used and often recommended for treating b-blocker and calcium channel blocker poisoning, and critical care nurses should be familiar with the therapy.

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