|
Читайте также: |
Although he was only in his early thirties, he moved like an old man with widespread arthritis. At the stairs, he supported himself on the short banister to keep his full weight off his feet. It looked as if every one of his muscles were in pain.
Inside his chart, in the section where he’d written his reason for the appointment were the words, “Poisoned by Levaquin.” He was the fourth such patient I’d seen in the past year or so.
Levaquin (generic name: levofloxacin) is the best-seller among antibiotics in the fluoroquinolone class (“floxins,” for short). Others include Cipro and Avelox. Still others you’ve never heard of because they’ve been yanked by the FDA for excessively dangerous side effects including heart, brain, and nerve damage. Because of these potential side effects, the general recommendation to doctors has been to use floxins only when absolutely necessary, choosing milder antibiotics (like Z-Pak or Augmentin) whenever possible.
But both doctors and patients like the floxins. They’re fast, effective, conveniently dosed at one per day, and generally reliable for difficult infections like sinusitis. For most users, they are safe. The floxins are so widely used in their various forms–intravenous, oral, even eye and eardrops–that hospital residents refer to Levaquin as “Vitamin L.” An important aside: this overuse has led to more cases of hospital acquired MRSA (methicillin resistant staph infection) and C. Difficile (hard-to-treat diarrhea) than other antibiotics. At a recent WholeHealth Chicago staff meeting, half of us, including me, acknowledged having taken a floxin at least once in our lives, and we all generally avoid drugs
(Iron poisoning)
Iron Poisoning
Hours post-ingestion
(Iron Poisoning
Etiology & Significance)
l In the 1980’s iron was the most frequent medication
associated with pediatric poisoning fatality
l Poisonings occur commonly with these preparations
because:
l They are brightly colored, taste sweet, and are shaped like
favorite characters
l They are available in large quantities
l They are not considered harmful by many parents
l They are commonly used during and after pregnancy, so
they are found in homes with small children.
(Uses of Iron)
l Treatment of iron deficiency anemia
l Supplemental intake of iron during pregnancy
l Multivitamin preparations
Toxicity of Iron
l Toxic dose: 10-20 mg elemental iron
l Fatal dose: 40-1600 mg/kg of elemental iron
Pathophysiology of Iron
Poisoning
l Cellular effects of iron
Fe+2 + H2O2 → Fe+3 + •OH + -OH
l Target organ damage
l GI Irritation => Vomiting (80%), Bloody diarrhea
l Damage to mucosal cells => Leukocytosis and fever
l Hemodynamic alterations
l Fluid shift from intravascular compartment to intracellular
space+bleeding => Hemoconcentration
l Results in decreased cardiac output and compensatory
increase in heart rate and systemic vascular resistance and
peripheral cyanosis
(Available Forms Of Iron)
l Oral
l Tablets (regular and sustained release), capsules, elixirs,
suspensions, syrups, and drops
l Prenatal products tend to contain 60 – 100 mg elemental
iron per tablet.
l Chewable multivitamins with iron tend to contain 15 – 18
mg elemental iron per tablet.
l Parenteral
l Iron dextran (ferric hydroxide complexed to dextran)
Vitamin A
l Available forms
l Food: Either preformed vitamin A (liver) or as carotenoids
(carrots).
l Vitamin Preparations: Multiple vitamins typically contain
5000 IU per dose
l Poisoning Manifestations
l Acute: Nausea, vomiting diarrhea, headache, drowsiness
irritability, and blurred vision. This is followed in 24-72
hours by extensive desquamation.
l Chronic: Bone abnormalities (asynchronous growth,
exostoses, metaphyseal flares, epiphyseal premature
closures), hepatotoxicity, intracranial hypertension (blurred
vision, headaches, diplopia), hypercalcemia
Vitamin A
l Toxic Dose
l Acute Toxic Dose: >25,000 IU/kg
l Chronic Toxic Dose: 25,000-50,000 IU/day for as few as
30 days.
l Treatment
l Supportive Care
l Increased intracranial pressure
§ Daily lumbar puncture, 40 mg IV furosemide, 1 gram/kg of
mannitol, 250 mg acetazolamide QID, a short course of
prednisone
l Hypercalcemia
§ Loop diuretics, IV fluids and prednisone (20 mg/day)
l Preventing absorption
l Activated charcoal, lavage, or ipecac syrup
Дата добавления: 2015-10-23; просмотров: 126 | Нарушение авторских прав
| <== предыдущая страница | | | следующая страница ==> |
| General characteristic of drug poisons | | | Практична частина |