dextromethorphan and Alcoholic-Intoxication

The incidence of serious pediatric morbidity and mortality has fortunately declined over the past two decades due to better prevention efforts, the development of regionalized poison information programs, and advances in the emergency management and critical care of poisoned patients. Still, children continue to explore and often ingest many substances they discover in their world. Some of these children will become patients who present to the emergency department, requiring a coordinated approach to the seriously or even critically ill poisoned child by physicians who can access specialized resources to manage a vast spectrum of potential toxins. This article summarized one such approach, emphasizing initial attention to life support priorities, followed by a detailed evaluation process using readily available clinical and laboratory data. Management strategies including decontamination, urgent antidotal therapy, initiation of excretion enhancement, and optimal supportive care were reviewed. Several specific intoxications were illustrated briefly in an attempt to facilitate pattern recognition of characteristic pediatric exposures.

Topics: Acetaminophen; Alcoholic Intoxication; Astemizole; Child; Child, Preschool; Clonidine; Cocaine; Critical Care; Dextromethorphan; Drug Overdose; Female; Humans; Hydrocarbons; Infant; Insecticides; Iron; Male; Organophosphorus Compounds; Poisoning

Compounds with anti-glutamatergic properties currently in clinical use for various indications (eg Alzheimer's disease, epilepsy, psychosis, mood disorders) have potential utility as novel treatments for alcoholism. Enhanced sensitivity to certain acute intoxicating effects (ataxia, sedative) of alcohol may be one mechanism by which anti-glutamatergic drugs modulate alcohol use. We examined the effects of six compounds (memantine, dextromethorphan, haloperidol, lamotrigine, oxcarbazepine, and topiramate) on sensitivity to acute intoxicating effects of ethanol (ataxia, hypothermia, sedation/hypnosis) in C57BL/6J mice. Analysis of topiramate was extended to determine the influence of genetic background (by comparison of the 129S1, BALB/cJ, C57BL/6J, DBA/2J inbred strains) and prior stress history (by chronic exposure of C57BL/6J to swim stress) on topiramate's effects on ethanol-induced sedation/hypnosis. Results showed that one N-methyl-D-aspartate receptor (NMDAR) antagonist, memantine, but not another, dextromethorphan, potentiated the ataxic but not hypothermic or sedative/hypnotic effects of ethanol. Haloperidol increased ethanol-induced ataxia and sedation/hypnosis to a similar extent as the prototypical NMDAR antagonist MK-801. Of the anticonvulsants tested, lamotrigine accentuated ethanol-induced sedation/hypnosis, whereas oxcarbazepine was without effect. Topiramate was without effect per se under baseline conditions in C57BL/6J, but had a synergistic effect with MK-801 on ethanol-induced sedation/hypnosis. Comparing inbred strains, topiramate was found to significantly potentiate ethanol's sedative/hypnotic effects in BALB/cJ, but not 129S1, C57BL/6J, or DBA/2J strains. Topiramate also increased ethanol-induced sedation/hypnosis in C57BL/6J after exposure to chronic stress exposure. Current data demonstrate that with the exception of MK-801 and haloperidol, the compounds tested had either no significant or assay-selective effects on sensitivity to acute ethanol under baseline conditions in C57BL/6J. However, significant effects of topiramate were revealed as a function of co-treatment with an NMDAR blocker, genetic background, or prior stress history. These findings raise the possibility that topiramate and possibly other anti-glutamatergic drugs could promote the acute intoxicating effects of ethanol in specific subpopulations defined by genetics or life history.

Topics: Alcoholic Intoxication; Animals; Ataxia; Carbamazepine; Central Nervous System Depressants; Conscious Sedation; Dextromethorphan; Ethanol; Excitatory Amino Acid Agents; Fructose; Haloperidol; Hypothermia; Lamotrigine; Male; Memantine; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Mice, Inbred DBA; Oxcarbazepine; Species Specificity; Stress, Psychological; Topiramate; Triazines