sodium-bicarbonate and Fever

The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation.(1-5) Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, non-compliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment.(6) In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication.(7) Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options.

Topics: Acidosis; Aggression; Anesthetics, Dissociative; Antipsychotic Agents; Behavior Therapy; Benzodiazepines; Delirium; Diagnosis, Differential; Emergencies; Fever; Fluid Therapy; Forensic Psychiatry; Humans; Hypothermia, Induced; Psychomotor Agitation; Sodium Bicarbonate

Topics: Diagnosis, Differential; Female; Fever; Humans; Hypernatremia; Infant, Newborn; Seizures; Sodium Bicarbonate

Poisoning with salicylic acid and its derivatives is a quite common event, leading to possibly life-threatening complications. A case of fatal intoxication of a sixty-year old patient with acetylsalicylic acid is described and the therapeutic options are discussed. In acute poisoning it is mandatory to initiate simple and effective measures first. This gives time for discussing and planning the more laborious procedures. The initial treatment of salicylate poisoning is based on the prevention of further absorption by a sufficiently large quantity of orally administered activated charcoal (approximately 1 g/kg b.w.). Given repeatedly, activated charcoal may enhance non-renal clearance of salicylates. Intravenously administered sodium bicarbonate counteracts the metabolic acidosis. Moreover, bicarbonate therapy limits tissue distribution of the drug and enhances its renal excretion. The availability of glycine for salicylic acid metabolism may be limited in poisoning because glycine has been used for forming the conjugation product salicyluric acid. Glycine may be administered orally to overcome this bottleneck. Gastric lavage has been proven to be of limited efficacy. This efficacy is further diminished if gastric lavage is performed late after drug ingestion. When it is performed, however, activated charcoal should be administered before and after gastric lavage. Whenever the more simple treatment options fail, hemodialysis or hemoperfusion should be additionally considered since these procedures are effective in removing salicylates from the body.

Topics: Aspirin; Charcoal; Coma; Fatal Outcome; Female; Fever; Gastric Lavage; Glycine; Hemoperfusion; Humans; Middle Aged; Poisoning; Renal Dialysis; Salicylates; Sodium Bicarbonate

Topics: Acetone; Acidosis; Adult; Anti-Bacterial Agents; Blood Glucose; Confusion; Diabetes Complications; Fever; Fluid Therapy; Humans; Leg Injuries; Male; Methicillin-Resistant Staphylococcus aureus; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Sodium Bicarbonate; Staphylococcal Infections; Vancomycin

The true incidence of malignant hyperthermia is unknown, but the frequency has been estimated as high as 1/14,000 anesthetic events. Review of the literature reports mortality rates up to 70%. Without prompt medical intervention, it is a uniformly fatal disease. Thus, it behooves the physician to have an awareness of the syndrome and its features, so that early recognition and adequate treatment take place. This paper presents a review of the literature on the occurrence, pathology, symptoms and treatment of malignant hyperthermia.

Topics: Acidosis; Bicarbonates; Calcium; Creatine Kinase; Dantrolene; Diuretics; Fever; Humans; Malignant Hyperthermia; Muscle Rigidity; Muscle Tonus; Sarcoplasmic Reticulum; Sodium Bicarbonate; Succinylcholine; Water-Electrolyte Imbalance