acyclovir and Vomiting

Topics: Acyclovir; Aphasia; Brain; Encephalitis, Viral; Fever; Herpes Simplex; Humans; Infant; Male; Seizures; Simplexvirus; Tomography, X-Ray Computed; Treatment Outcome; Vomiting

Acyclovir is an antiviral agent that causes termination of viral DNA synthesis by inhibiting viral reverse transcriptase. Acyclovir is used therapeutically to treat herpes simplex, cytomegalovirus, Epstein-Barr, and varicella-Zoster. Although acyclovir is thought to be low in toxicity, it has caused an obstructive nephropathy from accumulation of crystals in renal tissue. A retrospective review (January 1995 through March 2000) was conducted of acyclovir toxicoses in dogs reported to the ASPCA National Animal Poison Control Center. Of 105 ingestions, 10 were considered cases of acyclovir toxicosis. The most common signs seen were vomiting, diarrhea, anorexia, and lethargy. Ingested dosages ranged from 40 to 2195 mg/kg bw. Polyuria and polydipsia were reported in I dog. In 6/10 cases, signs developed within 3 h of ingestion. Treatment included standard decontamination procedures, (ie induction of emesis, administration of activated charcoal), diuresis, and supportive care.

Topics: Acyclovir; Animals; Anorexia; Antiviral Agents; Charcoal; Diarrhea; Diuresis; Dog Diseases; Dogs; Female; Male; Polyuria; Retrospective Studies; Vomiting

Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients.

Topics: Acyclovir; Adult; Creatinine; Follow-Up Studies; Herpes Zoster; Humans; Injections, Intravenous; Nausea; Pain; Random Allocation; Time Factors; Vomiting

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Creatinine; Female; Herpes Zoster; Humans; Infusions, Parenteral; Male; Nausea; Vomiting

Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients.

Topics: Acyclovir; Adult; Creatinine; Follow-Up Studies; Herpes Zoster; Humans; Injections, Intravenous; Nausea; Pain; Random Allocation; Time Factors; Vomiting

The work-up and initial management of a critically ill neonate is challenging and anxiety provoking for the Emergency Physician. While sepsis and critical congenital heart disease represent a large proportion of neonates presenting to the Emergency Department (ED) in shock, there are several additional etiologies to consider. Underlying metabolic, endocrinologic, gastrointestinal, neurologic, and traumatic disorders must be considered in a critically ill infant. Several potential etiologies will present with nonspecific and overlapping signs and symptoms, and the diagnosis often is not evident at the time of ED assessment.. We present the case of a neonate in shock, with a variety of nonspecific signs and symptoms who was ultimately diagnosed with tachycardia-induced cardiomyopathy secondary to a resolved dysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the diagnostic and therapeutic approach to the critically ill neonate in the ED, and expands the differential diagnosis beyond sepsis and critical congenital heart disease. Knowledge of the potential life-threatening etiologies of shock in this population allows the Emergency Physician to appropriately test for, and empirically treat, several potential etiologies simultaneously. Additionally, we discuss the diagnosis and management of supraventricular tachycardia and Wolff-Parkinson-White syndrome in the neonatal and pediatric population, which is essential knowledge for an Emergency Physician.

Topics: Acidosis; Acyclovir; Adenosine; Ampicillin; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Antiviral Agents; Cardiomyopathies; Cefotaxime; Electrocardiography; Emergency Service, Hospital; Feeding Behavior; Fluid Therapy; Glucose; Humans; Hypoglycemia; Hypotension; Hypoxia; Infant, Newborn; Lethargy; Male; Propanolamines; Propranolol; Shock; Tachycardia; Tachycardia, Supraventricular; Vomiting; Wolff-Parkinson-White Syndrome

Viral encephalitis are rare and potentially serious conditions with different etiologist, and not always identifiable. Our aim is to describe the etiological, clinical presentation and neurological outcome of viral encephalitis admitted in Paediatrics Intensive Care Units (PICUs) in Spain.. Observational prospective multicenter study. Children with viral encephalitis admitted to 14 PICUs, for a period of 3 years (2010-2013) were included. Polymerase chain reaction for the etiological diagnosis and neurotropic virus serology in blood and cerebrospinal fluid were used. Personal history, clinical presentation, evolution and neurological status at discharge were recorded.. 80 patients were included with a mean age of 5 years, 70% male. The most relevant clinical symptoms were decreased consciousness (86%), fever (82.4%), seizures (67%), vomiting (42%), headache (27%), agitation (25%) and dis-orientation (23%). The etiologic diagnosis was established in 35%, being more frequent herpes simplex virus and enterovirus. The outcome was discharge without sequelae in 55 patients (69%), mild to moderate sequelae in 19 (23.5%) and severe in 6 (7.5%). Two patients died.. In the Spanish PICU etiological diagnosis was established only in a third of cases of children with suspected acute viral encephalitis. Despite the clinical severity we observed a low mortality and morbidity rate. At discharge from the PICU, most children had no neurological sequelae or were mild.. Etiologia, presentacion clinica y evolucion neurologica de las encefalitis viricas graves en la edad pediatrica (estudio ECOVE).. Introduccion. Las encefalitis viricas son procesos raros y potencialmente graves, con etiologia diversa y no siempre identificable. El objetivo es describir las caracteristicas etiologicas, la presentacion clinica y la evolucion neurologica de las encefalitis viricas que ingresaron en las unidades de cuidados intensivos pediatricos (UCIP) en España. Pacientes y metodos. Estudio prospectivo multicentrico observacional. Se incluyeron los niños ingresados en 14 UCIP con diagnostico de encefalitis virica durante un periodo de tres años (2010-2013). Para el diagnostico etiologico se utilizo reaccion en cadena de la polimerasa y serologia a virus neurotropos en la sangre y el liquido cefalorraquideo. Se registraron los antecedentes personales, la presentacion clinica, la evolucion y la situacion neurologica en el momento del alta. Resultados. Se incluyeron 80 pacientes con edad media de 5 años; el 70%, varones. Los sintomas clinicos mas relevantes fueron disminucion de conciencia (86%), fiebre (82,4%), convulsiones (67%), vomitos (42%), cefalea (27%), agitacion (25%) y desorientacion (23%). Se llego al diagnostico etiologico en un 35%, y los mas frecuentes fueron virus herpes simple y enterovirus. La evolucion fue curacion sin secuelas en 55 pacientes (69%, sobre todo enterovirus, rotavirus y virus respiratorios), secuelas leves-moderadas en 19 (23,5%) y graves en seis (7,5%). Dos pacientes fallecieron. Conclusiones. En las UCIP españolas solo se realizo el diagnostico etiologico en un tercio de los niños con sospecha de encefalitis virica grave. A pesar de la gravedad clinica, hemos observado una tasa de mortalidad y morbilidad baja. La amplia mayoria son dados de alta de la UCIP con ninguna o escasa secuela neurologica.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Brain Damage, Chronic; Child; Child, Preschool; Clarithromycin; Consciousness Disorders; Encephalitis, Viral; Female; Fever; Headache; Humans; Infant; Male; Prospective Studies; Seasons; Seizures; Serologic Tests; Spain; Treatment Outcome; Vomiting

A 76-year-old man came to our hospital complaining of hiccups and vomiting lasting for five days. A neurological examination showed dysfunction of cranial nerves V, VII, VIII, IX and X on the left side. Cerebrospinal fluid polymerase chain reaction for varicella zoster virus-DNA was positive. The patient responded well to treatment with intravenous acyclovir and steroids. To the best of our knowledge, this is the first case report of zoster sine herpete presenting with persistent hiccups and vomiting. It is important to keep in mind that herpes zoster can present with symptoms that closely resemble those of intractable hiccups and nausea of neuromyelitis optica. Early detection of the virus is critical for making appropriate treatment decisions.

Topics: Acyclovir; Adrenal Cortex Hormones; Aged; Antiviral Agents; Cranial Nerve Diseases; DNA, Viral; Hiccup; Humans; Male; Polymerase Chain Reaction; Vomiting; Zoster Sine Herpete

We herein present a case of 6-year-old female demonstrating atypical Ramsay-Hunt syndrome. She presented with an earache, severe vertigo, and vomiting at onset, and thereafter, herpes zoster oticus appeared. No facial nerve palsy was seen. She was vaccinated for varicella and had no past history of apparent varicella infection. The patient showed positive IgG and negative IgM serum antibodies for varicella-zoster virus (VZV). An analysis of VZV-DNA from the patient's ear lesion using alleric discrimination real-time PCR identified a wild-type strain of VZV. We diagnosed her to have atypical Ramsay-Hunt syndrome caused by reactivation of the VZV. Aciclovir and prednisolone were administered, and she recovered completely. This case indicates that Ramsay-Hunt syndrome could be caused by a VZV infection after vaccination, even though its frequency is low. Ramsay-Hunt syndrome may thus be considered as one of causes of sudden onset vertigo in children.

Topics: Acyclovir; Chickenpox Vaccine; Child; Diagnosis, Differential; Earache; Female; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Prednisolone; Severity of Illness Index; Treatment Outcome; Vertigo; Vomiting

Herpes simplex is a common human pathogen that has rare but severe manifestations including encephalitis.. A 44-year-old man underwent uneventful resection of an acoustic neuroma. Postoperatively, he developed swinging pyrexia, vomiting, and episodic confusion. Analysis of cerebrospinal fluid showed a lymphocytosis, and polymerase chain reaction revealed herpes simplex DNA. After treatment of herpes encephalitis with acyclovir, the patient made a good recovery.. Herpes encephalitis is a rare complication of neurosurgical procedures, and the most likely etiology is reactivation of latent infection from manipulation of cranial nerves.

Topics: Acyclovir; Adult; Antiviral Agents; Consciousness Disorders; DNA, Viral; Encephalitis, Herpes Simplex; Facial Nerve; Facial Nerve Diseases; Fever; Humans; Magnetic Resonance Imaging; Male; Neuroma, Acoustic; Neurosurgical Procedures; Recurrence; Simplexvirus; Tomography, X-Ray Computed; Vestibulocochlear Nerve; Vomiting

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Bromodeoxyuridine; Diagnosis, Differential; Facial Paralysis; Female; Herpes Zoster Oticus; Humans; Treatment Outcome; Vertigo; Vomiting

Acute disseminated encephalomyelitis is an uncommon inflammatory demyelinating disease of the central nervous system. It generally presents after a nonspecific viral infection. We describe a case of a male adolescent who presented to the emergency department with vomiting and lethargy. A review of the pathophysiology and clinical presentation for acute disseminated encephalomyelitis is presented here.

Topics: Abdominal Pain; Acyclovir; Adrenal Cortex Hormones; Child; Demyelinating Autoimmune Diseases, CNS; Encephalomyelitis, Acute Disseminated; Gait Ataxia; Humans; Magnetic Resonance Imaging; Male; Mood Disorders; Prognosis; Respiratory Tract Infections; Vomiting

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Electroencephalography; Encephalitis, Varicella Zoster; Fever; Headache; Herpes Zoster; Humans; Male; Migraine Disorders; Photophobia; Vomiting

A 59-y-old with a history of chronic renal failure on hemodialysis was diagnosed with herpes zoster and begun on 800 mg acyclovir 5 times daily. Two days later the patient developed visual hallucinations, ataxia, confusion and memory loss along with focal myoclonus, nausea and vomiting. No fever, elevated WBC count or significant electrolyte imbalance was found. CT scan of the brain was unremarkable. The patient was then dialyzed for presumed acyclovir toxicity. Her acyclovir level was later found to have been 3.4 micrograms/ml (normal peak range 0.4-2 micrograms/ml) prior to dialysis. After 3 h of hemodialysis, her post-dialysis acyclovir level was 1.9 micrograms/ml. After a second course of hemodialysis the next day the patient's mental status improved, and she was discharged 5 d later. Due to its low volume of distribution (0.6 L/kg), low protein binding (about 15%) and water solubility, acyclovir is an example of the ideal drug that can be removed by hemodialysis. About 45% of the total body amount can be extracted through a 3-h course of hemodialysis with resultant improvement in symptoms.

Topics: Acyclovir; Antiviral Agents; Ataxia; Blood Chemical Analysis; Female; Hallucinations; Herpes Zoster; Humans; Kidney Failure, Chronic; Memory; Middle Aged; Myoclonus; Nausea; Renal Dialysis; Vomiting

Overall, acyclovir is a remarkably safe drug considering its potent antiviral effect. The most frequent reactions with short-term use of oral acyclovir are nausea and vomiting and with 6 months' use headache, diarrhea, nausea, and vomiting. These symptoms are also seen frequently with placebos. The most frequent adverse reaction to intravenous use has been inflammation and phlebitis at the injection site. The two most important serious adverse effects are (1) encephalopathic changes with abnormal electroencephalograms and lethargy, tremors, confusion, and seizures and (2) renal precipitation of the drug because of a rapid bolus of drug administered parenterally. Safety of acyclovir for use during pregnancy and in neonates and young children has not been established.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Animals; Chemical Precipitation; Diarrhea; Female; Headache; Humans; Injections, Intravenous; Kidney; Nausea; Pregnancy; Vomiting

Nausea and vomiting have not been clearly associated with parenteral acyclovir. We report a pediatric patient who developed nausea and vomiting apparently associated with intravenous acyclovir therapy. The child received acyclovir (1500 mg/m2/d) for treatment of recurrent varicella zoster with possible dissemination. Nausea and vomiting could be attributed only to acyclovir therapy. Discontinuing the drug resulted in a resolution of the adverse symptoms. Adverse effects of parenteral acyclovir can mimic the early manifestations of Reye's syndrome, which is an important consideration in children with viral infections. It is necessary to distinguish the cause of nausea and vomiting for proper management of patients.

Topics: Acyclovir; Child; Humans; Injections, Intravenous; Male; Nausea; Vomiting