Santiago Nogué-Xarau

Interés clínico de la semivida de eliminación del paracetamol como complemento al nomograma de Rumack en la valoración de la intoxicación por paracetamol

BACKGROUND AND OBJECTIVE Rumacks nomogram is usually used to indicate the treatment with N-acetilcysteine in the paracetamol poisoning, but it has several limitations. Paracetamol half-life elimination (t1/2) is approximately of 2 h with therapeutic doses and it increases to more than 4 h in patients with hepatotoxicity. The aim of this study was to determine the usefulness of estimated paracetamol t1/2 as greater than or inferior to 4 h by using a simple ratio in relation to the development of hepatotoxicity. PATIENTS AND METHOD 21 patients with paracetamol overdose were admitted to Son Dureta Hospital (Palma de Mallorca) and Clínic Hospital (Barcelona) over 13 months. The estimated t1/2 is calculated using the quotient between 2 plasma paracetamol concentrations separated by 2 or more hours. RESULTS We found a significant difference (p < 0.005) between the group with hepatotoxicity (n = 3; t1/2 = 8,5 h; range: 3,6 - 8,7 h); and without hepatotoxicity (n = 18; t1/2 = 2,4 h; (range: 1,6 - 4,3 h). We observed an agreement between positive ratio and a t1/2 > 4 h, and negative ratio with t1/2 < 4 h, bearing in mind that the quotient is obtained through mathematical equations. CONCLUSIONS Rumacks nomogram should be complemented with t1/2 estimation in all cases of paracetamol poisoning, especially with those patients for whom we are not able to determine the time of ingestion at presentation or if there has been a multiple-timepoint ingestion.

Documento de consenso sobre bloqueadores de los receptores betaadrenérgicos y consumo de cocaína

Cocaine use has risen exponentially in all European countries, particularly Spain and the United Kingdom, with a prevalence of users per capita very similar to that of the United States.1 The fact that cocaine use has become more widespread among Spanish youth is a matter of major concern.2 As a result, the number of users treated in hospital emergency rooms for medical problems resulting from acute intoxication,3 such as chest pain,4 has increased. The extent of the problem in terms of chronic effects, particularly cardiovascular effects,5 remains to be seen; these effects are likely to be associated with coronary disease.6,7 We have read with interest the consensus document on the use of beta-blockers written by a task force of the European Society of Cardiology and published in the Revista Espanola de Cardiologia,8 and would like to point out that no mention was made that these medications are contraindicated when an acute cardiac condition coexists with cocaine intoxication or overdose. In the case of acute coronary syndrome associated with cocaine use, vasospasms worsen in hypertensive patients treated with propranolol.9 Labetalol and esmolol are not effective, and alpha-adrenergic stimulation may actually exacerbate vasospasm and hypertension.10,11 Hence, benzodiazepines, nitroglycerin, and aspirin are recommended as first-line drugs. Alphaadrenergic receptors (phentolamine) and calcium blockers (verapamil) would be used for second-line hypertension therapy. In cases of ST segment elevation, primary percutaneous coronary angioplasty is recommended over fibrinolysis, which has a higher incidence of coronary vasospasm and a greater risk of bleeding in other organs.4 As toxicologists and emergency room physicians, we consider that the attending physician should take this contraindication into consideration not only in patients first seen for an acute coronary syndrome, but also in patients whose clinical condition

Letter by Burillo-Putze et al Regarding Article, “Acute Coronary Syndrome and Khat Herbal Amphetamine Use: An Observational Report”

To the Editor: We have read with interest the article by Ali et al and would like to offer some comments on acute coronary syndrome (ACS) associated with khat consumption from the point of view of its clinical impact in Europe.1 The prevalence of khat use in the European Union is seemingly low, but in the United Kingdom, Holland, and Norway2 it has been reported among first- and second- generation immigrants from East Africa and the …

Sobredosis grave de ketamina

1. Lachman HJ, Goodman HJ, Gilbertson JA, Gallimore JR, Sabin CA, Gillmore JD, et al. Natural History and Outcome in Systemic AA Amiloidosis. N Engl J Med. 2007;356:2361–71. 2. Sattianayagam PT, Hawkins PN, Gillmore JD. Systemic amiloidosis and gastrointestinal tract. Nat Rev Gastroenterol Hepatol. 2009;6:608–17. 3. Westermark P, Benson MD, Buxbaun JN, Cohen AS, Frangione B, Ikeda SI, et al. A primer of amyloid nomenclature. Amyloid. 2007;14:179–83. 4. Pepys MB. Amyloidosis. Annu Rev Med. 2006;57:223–41. 5. Dember LM. Amyloidosis-Associated Kidney Disease. J Am Soc Nephrol. 2006;17:3458–71. 6. Ebert EC, Nagar M. Gastrointestinal manifestations of amyloidosis. Am J Gastroenterol. 2008;103:776–87. 7. Verine J, Mourad N, Desseaux K, Vanhille P, Noël LH, Beaufils H, et al. Clinical and histological characteristics of renal AA amiloidosis: a retrospective study of 68

Presentación clínica, actitud terapéutica y evolución de las intoxicaciones agudas tratadas con carbón activado: ¿existen diferencias entre hombres y mujeres?

OBJECTIVE To determine whether there are gender-based differences in the clinical presentation, therapeutic approaches and outcomes in acute poisoning treated with activated charcoal. METHOD A descriptive study conducted in the Emergency Department of the Hospital Clínic de Barcelona over the 7 years between the years 2001 and 2008. The study included poisoned patients who had received activated charcoal. The variables included, epidemiological data, clinical and toxicological presentation, therapeutic approach, time in emergency department and outcomes. RESULTS A total of 575 patients were included in the study. The mean age was 37.8 (SD 14.8) years and 65.7% were females. No differences were observed between males and females with respect to age, number of drugs involved in the poisoning or the number of tablets ingested, but a higher prevalence of benzodiazepine poisoning was observed in females compared to males (69.8 vs. 61.2%; P<0.05). Alcohol combined with drug poisoning was more common in males than in females (32.4 vs.18.8%; P<0.001). Administration of activated charcoal in non-drug poisoning was also more common in males than in females (7.9 vs. 3.2%; P<0.05). There were no differences between genders as regards clinical presentation of the poisonings, delays in care, hours of emergency department stay, treatment or outcome. CONCLUSIONS Benzodiazepine poisoning was more prevalent in females than in males. Non-drug poisonings and alcohol combined with drug ingestion were more common in males. The clinical outcomes of the poisonings, delays in care, therapeutic requirements and admissions were similar between genders.