SUMMARYPrilocaine induced methemoglobinemia is a rare entity. In the present paper, the authors aim to draw attention to the importance of this rare condition by reporting this case. A 30-year-old female presented to Emergency Department with headache, dispnea and cyanosis. The patient has a history of 1000–1200 mg of prilocaine subcutaneous injection for hair removal at a beauty center, 5 hours ago. Tension arterial: 130/73 mmHg, pulse: 103/minute, body temperature: 37 °C and respiratory rate: 20/minute. The patient had acral and perioral cyanosis. Methemoglobin was measured 14.1% in venous blood gas test. The patient treated with 3 gr ascorbic acid intravenously. The patient was discharged free of symptoms after 48 hours of observation. Emergency physician should consider methemoglobinemia in presentation of dispnea and cyanosis after injection of prilocaine.
Metoclopramide, an antiemetic, is the most common cause of drug-induced dystonic reactions. 20-year-old female patient, complaining of involuntary bilateral upward medial deviation of the eyes, generalized muscle contractions and uncontrollable cry was brought into the emergency department(ED) by an ambulance. The diagnosis of the ambulance crew was conversion or seizure. The patient has all of dystonic reaction symptoms, including facial, neck, back, and extremity spasms, opisthotonus, oculogyric crisis, torticollis, trismus. The history revealed 40 mg of metoclopramide intake. Biperiden (5 mg) was infused in 100 ml saline. Symptoms were completely resolved. She was discharged from the ED. Drug-induced dystonic reactions can be confused with conversion, seizures, encephalitis, tetanus and hypocalcemic tetany. It is important for emergency physicians to know the drugs that may have dystonic reaction as potential side effects, recognize the clinical presentation of drug-induced dystonic reactions, and properly manage them in the ED.
Purpose: The purpose of this study was to investigate the role of serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the early detection of contrast-induced nephropathy (CIN).Methods: This prospective study enrolled 74 patients undergoing abdominal tomography with contrast (1 November 2014 -28 February 2015. Demographic properties (age and sex), symptoms and CT examination results were analysed. Sodium, potassium, urea, creatinine and NGAL levels were measured at 0 th , 6 th , and 72 nd hours. P value < 0.05 was considered statistically significant.Results: CIN developed in 16.2% of the study patients. The mean age was significantly higher in the patients who developed CIN (p<0.05). No significant correlation existed between the occurrence of CIN and patient gender (p>0.05). Urea levels did not differ significantly between the groups at 0 th and 6 th hours (p>0.05) but was significantly higher in the patients with CIN at 72 nd hour (p<0.05). Urea levels did not change significantly over time in the entire group (p>0.05). Creatinine level was not significantly different between the groups (p>0.05) but increased significantly over time (p>0.05). There were no significant differences between the groups with respect to NGAL levels at 0 th and 72 nd hours (p>0.05) whereas the group with CIN had a significantly higher NGAL level at 6 th hour (p<0.05). A NGAL level of 668 mg/dL at 6 th hour had a sensitivity of 100%, specificity of 95%, positive predictive value of 80% and negative predictive value of 100% for the detection of CIN.Conclusion: NGAL may be a useful marker for the early detection of CIN.
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