Highlights Acute OP poisoning complicated with pulmonary thrombosis during the first week of poisoning. Antidote treatment included atropine, whereas diazepam was administered in the first 48 h. There was no administration of oximes due to unavailability. Prolonged hypoxemia in acute OP intoxication indicates exclusion of thrombotic pulmonary event.
Introduction.Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage.Methods.An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2).Results.CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rdday (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5thday (R=0.3).Conclusion.In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rdday, a moderate correlation on admission and on the 5thday, which means that high cysLT and hematoma values were associated with high/moderate edema values.
In the 2020 annual report of the American Association of Poison Control Centers, 2562 toxic exposures to carbamazepine have been reported, 908 resulted in hospitalization, and among these about 5-6% were life-threatening or resulted in significant disability. A 15-year-old female patient was brought under suspicion of alcohol poisoning. The result of alcoholemia was 11.0mg/dL and the toxicological screening for THC, opiates, methadone, tramadol, amphetamine, MDMA, cocaine, benzodiazepines, buprenorphine was negative. At admission she was comatose (GCS=6), with metabolic acidosis, hypotension, rare short-term partial seizures, isochoric and later dilated pupils, body temperature was 36.4°C, with oxygen saturation from 89 up to 93%. Toxicological analysis were immediately extended. After three hours of admission, a result was obtained where the plasma concentration for carbamazepine was 167mmol/L. The patient was quickly prepared for hemodialysis which was performed for four hours. After 8 hours of admission the patient woke up with stable vital parameters.
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