Naloxone

 

Naloxone	Situation	Concern	References
Pregnancy	Category C		[1] [2]
Contraindicated	Allergy
controversial	Seizure	Naloxone alone reduced the number and duration of seizures but increased the number of mild seizures	[3 [4][5][6]
controversial	Alcohol intoxicated	Lacks effectiveness in ethylic coma	[7]
Precautions	Bronchospasm	Hypoxia risk	[8]
Precautions	COPD	Hypoxia risk	[2]
Precautions	Respiratory failure/ distress	Hypoxia risk	[2]
Precautions	Lung edema, non-cardiogenic	Hypoxia risk	[2]
Adverse effect	BPH	Acute urinary retention. (AUR)	[9]
Adverse effect	Acute abdomen, pancreatitis	Induced.	[10]
Treatment	Acute abdomen, IBD	Efective and safe, and could be considered for the treatment of therapy refractory IBD patients	[11]
Precautions	Liver, renal impaired function	Hepatitis	[2]
Contraindicated	hypothyroidism	Increment oxygen consumption, but not ventilation.	[12]

 

References

[1] Goldfrank’s p.541, 11th ed.

[2] https://www.ncbi.nlm.nih.gov/books/NBK534811/

[3] https://pubmed.ncbi.nlm.nih.gov/32133101/

[4] https://pubmed.ncbi.nlm.nih.gov/30676832/

[5] https://pubmed.ncbi.nlm.nih.gov/34051813/

[6] https://pubmed.ncbi.nlm.nih.gov/15167188/

[7] https://pubmed.ncbi.nlm.nih.gov/8115696/

[8] https://pubmed.ncbi.nlm.nih.gov/23380114/

[9] https://pubmed.ncbi.nlm.nih.gov/31975924/

[10] https://pubmed.ncbi.nlm.nih.gov/27922226/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845217/

[12] https://pubmed.ncbi.nlm.nih.gov/7800724/

Edited by Yu-Jang Su    Aug 13, 2022

Acute Bromate intoxication

 

Bromate intoxication
Year	Country	Aage	Gender	Symptoms	Reference
2019	Korea	48	Female	12 hours later Bilateral Deafness	[1]
2014	Japan				[2]
2006	Okayama, Japan	78	Female	Acute renal failure.	[3]
2002	Japan	48	Female	Hearing loss, anuria.	[4]
1993	Taiwan		Female	Gastrointestinal irritation, hypotension, fatigue, deafness, acute renal failure, anemia, and peripheral neuropathy	[5]
1993	Japan	34		Vomiting, epigastralgia, watery diarrhea,   and anuria appeared after 30, and deaf within 12 hours. Renal function recovered after Hemodialysis.	[6]
1992	Japan			Gastrointestinal symptoms, slight acute renal insufficiency.	[7]
1976	Japan	21	Male	Anemia and hypoproteinemia neuropathy, renal insufficiency	[8]
1971	Japan			Uremic neuropathy	[9]

1.      https://pubmed.ncbi.nlm.nih.gov/31846929/

2.      https://pubmed.ncbi.nlm.nih.gov/25771671/

3.      https://pubmed.ncbi.nlm.nih.gov/16508229/

4.      https://pubmed.ncbi.nlm.nih.gov/12508969/

5.      https://pubmed.ncbi.nlm.nih.gov/7910086/

6.      https://pubmed.ncbi.nlm.nih.gov/8365061/

7.      https://pubmed.ncbi.nlm.nih.gov/1285506/

8.      https://pubmed.ncbi.nlm.nih.gov/193541/

9.      https://pubmed.ncbi.nlm.nih.gov/4338750/

 

edited by Yu-Jang Su             July 24, 2022.    

The Age Distribution of Illicit Agents Users.

 

Year	Country	Age	n	Substance	Reference
2021	US	40.0 ±11.4	1362	illegal drug	https://pubmed.ncbi.nlm.nih.gov/34831700/
2022	Taiwan	36.0 ±30.0	675	illicit drugs	https://pubmed.ncbi.nlm.nih.gov/35315299/
2020	Taiwan	34.5 ± 10.0	203	illicit substance	https://pubmed.ncbi.nlm.nih.gov/32037264/
2016	Switzerland	33	210	psychoactive substances	https://pubmed.ncbi.nlm.nih.gov/27228985/
2017	Switzerland	33	503	recreational drug toxicity	https://pubmed.ncbi.nlm.nih.gov/28264690/
2021	UK	31.2 (SD 10.0)	283	ketamine	https://pubmed.ncbi.nlm.nih.gov/34092131/
2021	Spain	31	17198	acute drug toxicity	https://pubmed.ncbi.nlm.nih.gov/33724118/
2016	Japan	30	589	novel psychoactive substances	https://pubmed.ncbi.nlm.nih.gov/27314752/
2016	Germany	26.9	13	gamma hydroxybutyrate	https://pubmed.ncbi.nlm.nih.gov/26395197/
2022	Taiwan	25.5	24	Nitrous Oxide	https://pubmed.ncbi.nlm.nih.gov/35324737/

 Edited by Yu-Jang Su   June 26, 2022. 

SSRI (selective serotonin reuptake inhibitor)

 SSRI (selective serotonin reuptake inhibitor) 血清素再吸收阻斷劑

SUBSTANCE

 

-          Newer and safer antidepressant compared to TCA [1].

-          Lower ADR than TCA.

 

 

Common name or Trade name 

 

-          Fluvoxamine、Paroxetine、Sertraline、Citalopram、Escitalopram、Fluoxetine。

 

 

Involving SYSTEM

 

-          Serotonin,  about 98% in extra-CNS [2]。

-          A long elimination half-life, with sustained biological activity due to active metabolites

-          In overdose, SSRI elimination times are further prolonged by the saturation of metabolic enzymes and by delayed absorption, especially for sustained-release preparations.

-          Electrolyte imbalance: hyponatremia, easily seen in the elderly [3].

-          Neural system: extra-pyramidal, hyperreflexia, Clonus, myoclonus [4].

-          Respiratory system: failure. Cough.

-          Gastrointestinal system: nausea, upset.

 

Presentation

 

-          Cause vomiting, mild CNS depression, or tremor.

-          Hyponatremia.

-          Unstable blood pressure. Arrhythmia. VT. Arrest, QRS QTc prolongation, Torsades de pointes [5].

-Bradycardia, hypotension: Fluvoxamine (Luvox)

- hyperreflexia, Clonus, myoclonus.

- Sweating, agitation.

- fever, coma, seizure (1.9%) [6].

 

Antidote and Treatment 

 

-          BLS, gastric lavage < 1 hr.  

-          Activated charcoal.

-          Not recommended for laxative.

-ACLS, inotropic agent.

-Nitroglycerin或Nitroprusside for hypertension。

-  magnesium sulfate 2 g IV over 2 min for Torsades de points

-  wide QRS: NaHCO3 1 to 2 mEq/kg IV push

- (benzodiazepine, BZD) for seizure.

- Serotonin antagonist:

     -Cyproheptadine (oral form; sedation) [7]. 12 mg, followed by 2 mg every 2 h if symptoms continue. 

- (Extrapyramidal signs): Diphenylhydramine 50mg bid。

 

Disposition

 

-          Suspicious: observe 6-8 hours with ECG monitoring, if no symptoms, then may be discharged.

-          Citalopram, need observe longer to 12hours, observe arrhythmia / convulsion [8].

 

REFERENCES

 

[1]. https://pubmed.ncbi.nlm.nih.gov/35206480/

[2]. https://pubmed.ncbi.nlm.nih.gov/19361459/

[3]. https://pubmed.ncbi.nlm.nih.gov/34483534/

[4]. https://pubmed.ncbi.nlm.nih.gov/23391344/

[5]. https://pubmed.ncbi.nlm.nih.gov/31845095/

[6]. https://pubmed.ncbi.nlm.nih.gov/30521236/

[7]. https://pubmed.ncbi.nlm.nih.gov/20833944/

[8]. https://pubmed.ncbi.nlm.nih.gov/33489987/

 

Edited by Yu-Jang Su                 May 26, 2022,  

                                                    June 21, 2026 revision.

Drug Overdose

 

Finding	Substance	Country	Reference
Top three types of substances were benzodiazepine (42.9%), mixed medications (32.1%), and acetaminophen (6.1%). Mean age: 39.2±18.3 years old Male intentional overdose patients were 8.1 years older than their female counterparts (45.3±19.5 vs. 37.2±17.5, respectively; P<0.05). Most intentional overdose cases occurred during the spring season (n=63, 32.1%), especially in male patients (n=28, 57.1%; P<0.001). Approximately 11.2% and 2% of the total patients were admitted to the Toxicology ward and intensive care units, respectively.	Overdose	Taiwan	[1]2022
Mean age of the cases was 23.1 +/- 7.3 years 84.1% of them were females. The risk factors were more significantly associated with males: chronic ethanol intake (p = 0.04), higher reported dose ingested (p = 0.01), higher latency time (p = 0.04) and longer hospital stay (p = 0.03).	Acetaminophen	Malaysia	[2]2010
Majority of cases were men (78%) Mean age was 37 years. (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most  common place of death (67%). Women were 4 years older.	Drug-induced death	Norway	[3]2013
Suicide attempts occurred more frequently between May and November, and on Tuesdays.	overdose	Hong Kong	[4]2013
The mortality rate for overdose was 16.6 per 1000 PY for males and 13.74 per 1000 PY for females. In the multivariate regression analysis, the time from first ED overdose access (less than 1 year risk ratio [RR]: 7.07, 95% confidence interval [CI]: 5.32-9.39) was significantly associated with death by overdose. Males, subjects aged >30 years at presentation, patients who refused ED treatment, and those having previously contacted mental health services showed an increased mortality risk due to overdose.	overdose	Italy	[5]2016
Female sex (odds ratio [OR], 2.41); comorbid renal disease (OR, 4.22); untreated sleep apnea (OR, 32.32); receipt of long-acting oxycodone (OR, 4.76); and as-needed use of hydromorphone (OR, 2.73) were significant predictors of oversedation.	Overdose	United States	[6]2018

[1] https://www.spandidos-publications.com/10.3892/br.2022.1532

[2] https://pubmed.ncbi.nlm.nih.gov/20737523/

[3] https://pubmed.ncbi.nlm.nih.gov/23302498/

[4] https://pubmed.ncbi.nlm.nih.gov/24011683/

[5] https://pubmed.ncbi.nlm.nih.gov/26914353/

[6] https://pubmed.ncbi.nlm.nih.gov/30190295/

 Edited by Yu-Jang Su   April 21, 2022.