pituitrin and Drug-Overdose

Topics: Acetaminophen; Acetylcysteine; Adult; Barbiturates; Caffeine; Drug Combinations; Drug Overdose; Female; Hemoperfusion; Humans; Renal Dialysis; Treatment Outcome; Vasopressins; Xanthines

Topics: Acute Disease; Anti-Anxiety Agents; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atropine; Cardiac Pacing, Artificial; Dopamine; Drug Overdose; Fluid Therapy; Humans; Hypertension; Hypotension; Isoproterenol; Nitroglycerin; Poisoning; Practice Guidelines as Topic; Propranolol; Vasopressins

Venlafaxine overdose can lead to cardiovascular collapse that is difficult to resuscitate with traditional Advanced Cardiovascular Life Support protocols. Evidence has suggested that lipid emulsion infusion therapy has been successful in the treatment of antidepressant overdose. No studies have determined the optimal combination of lipid/advanced cardiovascular life support therapy for treatment.. This study was a prospective, experimental, between subjects design with a swine model investigating the effectiveness of drug combinations administered with cardiopulmonary resuscitation (CPR) postvenlafexine overdose. Subjects were randomly assigned to 1 of eight groups containing seven subjects. The groups tested were CPR only and CPR with epinephrine alone; vasopressin alone; lipid alone; epinephrine and vasopressin; epinephrine and lipid; vasopressin and lipid; and epinephrine, vasopressin, and lipid. The outcomes of interest were survival odds and time to return of spontaneous circulation.. Results on these swine models indicate that the use of vasopressin coupled with lipids for venlafaxine overdose resulted in a higher survival rate when compared to the control group (p = 0.023). Groups receiving vasopressin experienced statistically faster times to return of spontaneous circulation than other groups (p = 0.019).. The results suggest that in swine models, the optimal treatment for venlafaxine overdose would include vasopressin with lipids.

Topics: Animals; Cardiopulmonary Resuscitation; Drug Overdose; Drug Therapy, Combination; Epinephrine; Fat Emulsions, Intravenous; Humans; Male; Odds Ratio; Prospective Studies; Random Allocation; Serotonin and Noradrenaline Reuptake Inhibitors; Survival Rate; Swine; Vasoconstrictor Agents; Vasopressins; Venlafaxine Hydrochloride

The aim of this study was to investigate the effects of different treatment combinations on bupropion recovery as well as time to return of spontaneous circulation.. We conducted an eight group, randomized, experiment to evaluate combinations of epinephrine, vasopressin, and lipids on the restoration of cardiac function in Yorkshire pigs. After tracking the animals' baseline vitals for 10 minutes, we injected the animals with bupropion (35 mg/kg) and initiated a randomized protocol 2 minutes after cardiac arrest.. Results demonstrated that animal survival given treatment combinations including epinephrine were statistically superior to any other group (p < 0.001, Fishers' exact test). The odds of survival with use of epinephrine vs. other options were 22:1 (5.47, 88.43). Further, all animals receiving only lipids died. Cox survival analysis with bootstrapped parameter estimates provided evidence that the rapidity of cardiac recovery was maximized with a combination of epinephrine and lipids (p < 0.05).. Lipids may require an additional chemical catalyst in order to be effective in cardiac recovery. Epinephrine and lipids combined shortened recovery time for surviving animals.

Topics: Animals; Bupropion; Cardiopulmonary Resuscitation; Drug Overdose; Epinephrine; Fat Emulsions, Intravenous; Heart Arrest; Humans; Models, Animal; Prospective Studies; Swine; Vasopressins

Topics: Antipsychotic Agents; Clozapine; Drug Overdose; Emergency Service, Hospital; Female; Humans; Hypotension; Vasoconstrictor Agents; Vasopressins; Young Adult

A toxic dose of desipramine (tricyclic antidepressant) causes cardiac arrhythmias and ultimately asystole. Resuscitation is difficult and almost always unsuccessful. Anecdotal evidence suggests that an infusion of lipid emulsion may be an effective treatment. The purpose of this study was to determine the optimal combination of lipid rescue and traditional Advanced Cardiac Life Support therapy for the treatment of desipramine overdose. We use a prospective, experimental, between subjects design with a swine model investigating the effectiveness of the drugs and drug combinations administered with cardiopulmonary resuscitation. Subjects were randomly assigned to 1 of 8 cardiopulmonary resuscitation/drug combination interventions, and the results from each group were compared using an analysis of variance and post hoc Tukey where appropriate. The groups that received vasopressin were more likely to survive than those that did not receive vasopressin, and the groups that received lipid emulsion were more likely to survive than those that did not receive lipid emulsion. Vasopressin alone was shown to be the most effective treatment in the management of desipramine overdose. The results of this study may warrant changes in treatment protocols for desipramine overdose.

Topics: Adrenergic Agonists; Advanced Cardiac Life Support; Animals; Antidepressive Agents, Tricyclic; Antidiuretic Agents; Blood Pressure; Cardiopulmonary Resuscitation; Desipramine; Disease Models, Animal; Drug Overdose; Electric Countershock; Epinephrine; Fat Emulsions, Intravenous; Heart Massage; Heart Rate; Male; Random Allocation; Resuscitation; Survival Rate; Swine; Vasopressins

Disclosure of health care incidents to patients and family members, as an ethical imperative, is becoming increasingly prevalent. The experiences of a woman whose husband died forms the basis for a case study of how she and her family and friends were able to renegotiate clinicians' understandings of what had gone wrong and influence their views of what needed to be done in response.. The case was constructed in late 2010 using the replicated single-case approach, which involved repeated checking and correcting details of an interview with the patient's wife. Her husband, diagnosed with multiple myeloma in 2006, was hospitalized in January 2009 following a hip replacement. While in the hospital, he received a vasopressin overdose. He died in February 2009. THE DISCLOSURE PROCESS: The basis of the disclosure was the drug error, yet the patient's wife informed the caller (the head of the ICU), "You've got a greater problem than a drug error... you've got a massive, big communication problem here." The disclosure process, which unfolded in a series of phone calls and meetings, enabled the patient's wife and her family not only to ask questions but to put forward their knowledge, views, and concerns, and it moved from "disclosing an incident" (the vasopressin overdose) to addressing repeated communication failures and inappropriate behaviors. As a result, the disclosure process became a genuine dialogue that informed the clinicians as much as the family.. This case study expands our understanding of what is possible as part of disclosure communication. Patients and family members can and should play a critical role in quality improvement and patient safety, given their knowledge and questions about the trajectory of care and their passion for ensuring that similar incidents do not recur to harm others.

Topics: Blood Transfusion; Communication; Confidentiality; Disclosure; Documentation; Drug Overdose; Female; Hemostatics; Humans; Interviews as Topic; Male; Medication Errors; Physician-Patient Relations; Quality of Health Care; Vasopressins

Topics: Acidosis, Lactic; Adrenergic alpha-Agonists; Anti-Inflammatory Agents; Antidiuretic Agents; Drug Overdose; Epinephrine; Glucose; Humans; Hydrocortisone; Hypoglycemic Agents; Insulin; Male; Metformin; Middle Aged; Norepinephrine; Sodium Bicarbonate; Suicide, Attempted; Treatment Outcome; Vasopressins

A 27-year-old man with schizophrenia took an overdose of a psychotic agent. He became unconscious and had severe hypotension. Although he was diagnosed as having distributive shock caused by drug overdose and treated by hydration and catecholamine, the shock status was lasting. The use of vasopressin changed the situation dramatically. After the injection of vasopressin at maximum dose, 0.1 U/min, the dose of vasopressin could be tapered. He recovered from shock and was discharged on the third day without sequelae. There are an increasing number of reports that indicate that vasopressin is effective for distributive shock, especially catecholamine-resistant septic shock. It seems that the appropriate dose of vasopressin is under 0.04U/min considering the deterioration of cardiac function although the maximum dose of vasopressin was O.1U/min in this case. For that reason, monitoring by pulmonary artery catheter is recommended. The side effects of vasopressin should be discussed for appropriate use.

Topics: Adult; Antidiuretic Agents; Antipsychotic Agents; Catecholamines; Drug Overdose; Humans; Injections, Intravenous; Male; Schizophrenia; Shock; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Treatment of hypotension caused by calcium channel blocker overdose (CCB) remains a challenge. We describe the successful use of vasopressin in two patients with massive CCB overdoses in whom hypotension was unresponsive to calcium, glucagon, insulin, and conventional vasopressor therapies. While various modes of treatments have been used to treat the hypotension of CCB overdose, this is the first report to our knowledge of the successful use of vasopressin in this clinical setting.

Topics: Adult; Amlodipine; Antidotes; Blood Pressure; Calcium Channel Blockers; Diazepam; Diltiazem; Drug Overdose; Drug Therapy, Combination; Female; Humans; Hypotension; Middle Aged; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Due to neurotransmitter reuptake inhibition, peripheral alpha receptor blocking effects, and sodium channel blockade, severe cyclic antidepressant poisoning may lead to intractable hypotension. We report a case of severe amitriptyline toxicity, with hypotension unresponsive to direct alpha receptor agonists after pH manipulation, but improved with intravenous vasopressin. Vasopressin use in the setting of cyclic antidepressant toxicity has not been previously reported. Vasopressin may be a beneficial agent in the treatment of recalcitrant hypotension associated with poisoning or overdose. The anecdotal nature of this report must be emphasized and the use of vasopressin requires further research to define efficacy, dose, and potential side effects.

Topics: Amitriptyline; Antidepressive Agents, Tricyclic; Drug Overdose; Humans; Hypotension; Male; Middle Aged; Vasoconstrictor Agents; Vasopressins

Massive caffeine overdose is associated with life-threatening hemodynamic complications that present challenges for clinicians. We describe the highest-reported serum concentration of caffeine in a patient who survived and discuss the first-reported use of vasopressin and hemodialysis in a caffeine-poisoned patient.. A 41-yr-old woman presented 3 h after ingesting approximately 50 g of caffeine. She subsequently underwent cardiopulmonary resuscitation and received multiple medications in an attempt to raise her blood pressure and control her heart rate without success. Vasopressin infusion increased her blood pressure to the point where hemodialysis could be performed. Despite ensuing multisystem organ failure, she survived and has made a complete recovery.. Hemodialysis and vasopressin infusions may be of benefit in the management of caffeine-intoxicated patients who fail to respond to standard therapies.

Topics: Adult; Blood Pressure; Caffeine; Drug Overdose; Female; Heart Rate; Humans; Infusions, Intravenous; Renal Dialysis; Suicide, Attempted; Treatment Outcome; Vasopressins