pituitrin and Poisoning

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

We compared the efficacy of vasopressin and glucagon in a porcine model of beta-blocker toxicity. Our primary outcome was survival over 4 hours.. Sixteen pigs received a 1-mg/ kg bolus of propranolol IV followed by continuous infusion at 0.25 mg/kg/minute. Toxicity was defined as a 25% decrease in the product of heart rate (HR) and mean arterial pressure (MAP), at which point 20 mL/kg normal saline was rapidly infused. Each pig was randomly assigned to receive either vasopressin or glucagon after the saline bolus. The vasopressin group received a continuous infusion at 0.0028 U/kg/minute, titrated up to a maximum of 0.014 U/ kg/minute. The glucagon group received a 0.05-mg/kg bolus followed by continuous infusion at 0.15 mg/kg/hour. The HR, MAP, systolic BP (SBP), cardiac output (CO), glucose, and pH were monitored for 4 hours from toxicity or until death.. One pig survived at 4 hours (vasopressin group). Analysis of the 4-hour Kaplan-Meier survival curves found no differences between the groups (log-rank test 0.059, p = 0.81). No overall differences were identified in MAP, systolic BP, cardiac output, glucose, pH, or HR. However, over the first hour MAP and SBP were significantly higher in the vasopressin group (p = 0.004, p = 0.006, respectively).. In this beta-blocker toxicity model, there were no differences in the survival curves between vasopressin- and glucagon-treated pigs during a 4-hour analysis period. No overall differences were noted in MAP, systolic BP, CO, HR, pH, or glucose levels, although vasopressin treatment yielded higher MAP and systolic BP early in resuscitation.

Topics: Adrenergic beta-Antagonists; Animals; Blood Pressure; Disease Models, Animal; Glucagon; Heart Rate; Hemodynamics; Poisoning; Propranolol; Survival Rate; Swine; Vasoconstrictor Agents; Vasopressins

A 39-year-old man was hospitalized after divalproate self-poisoning. He presented coma requiring tracheal intubation and mechanical ventilation at 11 hours and central diabetes insipidus. Serum valproic acid concentration was 590 mg/l at 30 hours. Progressive improvement occurred after hydratation and administration of vasopressin.

Topics: Adult; Bipolar Disorder; Coma; Diabetes Insipidus; Fluid Therapy; Humans; Intubation, Intratracheal; Male; Poisoning; Polyuria; Respiration, Artificial; Suicide, Attempted; Valproic Acid; Vasopressins

Vasopressin is a novel vasopressor agent used for intractable hypotension. There is little published data available on its use in the poisoned patient. We performed a randomized, controlled, blinded trial in a porcine model to study the effects of vasopressin infusion on mean arterial pressure after verapamil poisoning.. Eighteen anesthetized monitored swine received a verapamil infusion of 1 mg/kg/hr until the mean arterial pressure (MAP) had decreased to 70% of baseline. At this time, a continuous infusion of either vasopressin (0.01 U/kg/min) or an equal volume of normal saline was initiated. The swine were monitored for 60 minutes after initiation of the study infusion. The primary outcome was MAP.. There was no statistically significant difference between the two groups in MAP, cardiac output or systemic vascular resistance. One half (four of eight) of the animals in the vasopressin group died, compared with 20% (two of ten) of those in the saline group.. Vasopressin infusion decreased the survival of verapamil-poisoned swine when compared to those treated with saline alone in this experimental model.

Topics: Animals; Antidotes; Blood Pressure; Cardiac Output; Disease Models, Animal; Heart Rate; Longevity; Male; Poisoning; Single-Blind Method; Swine; Vasoconstrictor Agents; Vasodilator Agents; Vasopressins; Verapamil

The herbicide BASTA (AgrEvo, Germany), containing glufosinate ammonium (20%) and an anionic surfactant, polyoxyethylene alkylether sulfate (33%), is widely used. In acute oral BASTA poisoning, patients develop a variety of clinical signs, including disturbed consciousness, convulsions, and apnea. These effects are suspected to be due to the effects of glufosinate on the central nervous system.. A 60-year-old man ingested 500 mL of BASTA herbicide in a suicide attempt. He developed not only unconsciousness, respiratory distress, and convulsions but also an increase in urine output (7885 mL/d), elevated serum sodium (167 mEq/L), elevated plasma osmolality (332 mOsm/kg), and a decrease in both urine osmolality (200 mOsm/kg) and urine specific gravity (1.003), which suggested the development of diabetes insipidus. The plasma level of antidiuretic hormone remained within the normal range (1.3 pg/mL), despite high plasma osmolality. The administration of desmopressin was successful in normalizing urine volume, specific gravity, and osmolality. Serum sodium corrected gradually within 48 hours. The possible mechanisms causing the diabetes insipidus are discussed.

Topics: Aminobutyrates; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemoperfusion; Herbicides; Humans; Male; Middle Aged; Poisoning; Renal Dialysis; Suicide, Attempted; Urine; Vasopressins

Topics: Adrenocorticotropic Hormone; Anemia; Anemia, Myelophthisic; Anti-Bacterial Agents; Ascorbic Acid; Benzene; Biopsy; Blood Transfusion; Cortisone; Female; Hematologic Diseases; Hematology; Leukemia; Liver Extracts; Mortality; Occupational Diseases; Pathology; Poisoning; Prednisolone; Prednisone; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Tetracycline; Toxicology; Vasopressins; Vitamin B 12