SummaryIn recent years an increasing number of different energy drinks have been introduced to provide an energy boost. They contain high levels of caffeine and other additives that act as stimulants. Several recent studies present that energy drinks could increase the risk of seizures, acid-base disorders and cardiovascular events. The authors report a 28-year-old man who was brought to the emergency room after sudden onset of tonic-clonic seizures and metabolic acidosis after drinking several cans of a caffeinated energy drink. The authors believe that this clinical picture was caused by caffeine intoxication from an energetic drink causing a syndrome of catecholamine excess. The patient was discharged within a week with no complaints and no neurological signs. Finally, recognising the features of caffeine intoxication and its potential health consequences may be especially relevant when treating younger persons who may be more likely to consume energy drinks.
In recent years an increasing number of different energy drinks have been introduced to provide an energy boost. They contain high levels of caffeine and other additives that act as stimulants. Several recent studies present that energy drinks could increase the risk of seizures, acid-base disorders and cardiovascular events. The authors report a 28-year-old man who was brought to the emergency room after sudden onset of tonic-clonic seizures and metabolic acidosis after drinking several cans of a caffeinated energy drink. The authors believe that this clinical picture was caused by caffeine intoxication from an energetic drink causing a syndrome of catecholamine excess. The patient was discharged within a week with no complaints and no neurological signs. Finally, recognising the features of caffeine intoxication and its potential health consequences may be especially relevant when treating younger persons who may be more likely to consume energy drinks.
SUMMARYLyell's syndrome or toxic epidermal necrolysis (TEN) is a rare dermatological disease that causes serious morbidity and mortality. It is most commonly drug induced. The authors report the case of a 57-year-old woman who was admitted to our hospital with severe rash all over the body. She had been previously submitted to brain surgery for total resection of a large meningioma and medicated with phenytoin for seizures prophylaxis. During this treatment, erythematous lesions and blisters were observed first on her face and trunk and then spreading to the entire body. Detachment of the skin, as well as mucous involvement especially of mouth and conjunctiva, was also observed. TEN was diagnosed, and phenytoin was discontinued. Intravenous fluids, systemic steroids and tightened infection control measures were implemented. After 10 days, skin recovery and reepithelialisation were established, temperature decreased and mucosal complications stabilised. The patient was discharged after 1 month of hospitalisation.
BACKGROUND
A 26 year-old man arrested for presumed drug smuggling was brought to the Emergency Room complaining of diffuse abdominal pain, nausea and bloating for 48 hours. He denied fever, constipation, diarrhea or vomiting. He smoked 20 cigarrettes/day and denied taking any medication or drug. His father had died of colorectal cancer at the age of 40. At physical examination, the patient presented tachycardia (120 bpm), fever (38.2 º C) and diaphoresis. At abdominal examination, he had no abdominal distension and the bowel sounds were normal. He had no palpable masses, organomegalies or signs of peritoneal irritation. Blood pressure was 120/80 mmHg and respiratory rate was 20 cpm, with 98% SatO 2 on oximetry. Cardiac and pulmonary auscultation, as well as the neurological examination were unremarkable. Electrocardiogram revealed sinusal tachycardia. Laboratory studies showed normal white blood cell count, C-reactive protein level, liver and renal function tests. Lipase and troponin-I levels were normal. Fever subsided after 1 g of acetaminophen. An upright abdominal x-ray was performed (Fig.).The plain abdominal X-ray showed numerous hypotransparent nodules in the entire colon, without small or large bowel dilation, pneumoperitoneum or bowel obstruction. The nodules corresponded to the drug capsules the patient had ingested before his arrest. Since there were no signs of severe acute cocaine
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