Carbon monoxide (CO) has been shown to be teratogenic in mice. High altitude hypoxia has also been shown to induce congenital vertebral anomalies in mice. The purpose of this study was to investigate the effect of maternal hypoxia owing to CO exposure and the production of congenital spinal deformities in the offspring. Sixty DBA-1J mice were bred using polygamous timed breeding methods. Pregnant females were exposed to 200, 400, or 600 ppm CO using a custom-designed gas blender system. Seven-hour exposures were performed on day 8.5, 9.5, or 10.5 of the 21-day gestation cycle. The neonates were euthanized at birth; the specimens were fixed, eviscerated, and radiographed. Congenital spinal deformities were observed (wedge, hemi, fused, and missing vertebrae; fused ribs) and were located in all regions of the spine. There was a statistically significant difference in the number of spinal deformities between all groups, with no defects in the controls and a 77% incidence at 600 ppm (p < 0.0001). There was no apparent correlation between the time of exposure and defect location. The most sensitive time of gestation was 9.5 days. We identified an animal model of congenital spinal deformities that compares favorably with the evidence of human congenital spinal deformities in cases of maternal exposure to CO and other gas and chemical fumes.
Background:
Lamotrigine is a phenyltriazine medication that has been approved by the
United States Food and Drug Administration as monotherapy and as an adjunctive agent for the
treatment of seizure disorder. It was later approved by the FDA for the treatment of bipolar disorder.
Lamotrigine is generally well tolerated by patients, but some serious symptoms can occur during
treatment. These severe side effects include rashes and multi-organ failure. Lamotrigine has also
been associated with the development of mental status changes, frequently when used concurrently
with other medications that may impact the metabolism of lamotrigine.
Objective:
To present the case of a 65-year-old man being treated with lamotrigine and valproic acid
who developed mental status changes after the addition of sertraline to his medication regimen,
and to compare this case to existing cases reported in the literature.
Discussion:
Our case adds to the existing literature by demonstrating that patients may experience
adverse medication effects despite lamotrigine levels that are normally considered to be in the therapeutic
range, highlighting the importance of clinical correlation when obtaining medication levels.
Conclusion:
Clinicians should use caution interpreting lamotrigine levels when working up delirium,
as normal levels may not rule out the development of lamotrigine toxicity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.