MAO Inhibitors: Predicting Response/Maximizing Efficacy
Mark S. Gold, R. Bruce Lydiard, John S. Carman in Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Overdose with MAOI presents a complicated and very serious situation.1,66 Lethal dosage represents approximately a 1-week supply of the normal therapeutic dose. Symptoms may appear only after a delay and may be long lasting with the irreversible hydrazine inhibitors; e.g., phenelzine (these patients should be observed in the hospital for 1 week). Prominent symptoms include agitation, hallucinations, hyperreflexia, hyperpyrexia, confusion, and convulsions. Either severe hypotension or hypertension may occur. Gastric emptying by emesis and lavage and dialysis can markedly decrease amount of drug exposure. The potential dangers associated with regulating blood pressure require close monitoring with IV management. Hyperpyrexia must be aggressively addressed with external cooling, antipyretics, and perhaps curarization to reduce heat output from overactive musculature. Other supportive measures (fluids, electrolytes, ventilation) are also necessary. Management may also be complicated by concomitant ingestion of other psychotropic drugs (e.g., TCA) and pressor agents (including prohibited tyramine-containing foodstuffs).
Physical technology and biological basis of hyperthermia in oncology
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
High temperature has follow-up effects on the cells. Cell activity decreases after stimulation with high temperature, which is most obvious after 6–18 hours, and then they start their self-repair. Tests show that the cells are blocked at phase G2 within 6–24 hours after the heat treatment. Continuous hyperpyrexia treatments allow cells to generate tolerance. The cell thermal tolerance mechanism is not definitive now, and it is a representation of the body’s self-protection mechanism. As for high-temperature-inducing apoptosis, the changes of cell nuclei and mitochondria are the most significant. Mitochondrial damage is the central link of apoptosis, and in the early apoptosis period, there appear an interruption of electron transfer chains of the mitochondria, obstruction of energy generation, increase of membrane permeability, reduction of transmembrane potential, opening of membrane permeability pores, and so on. The opening of hole canals balances the ion concentration inside and outside the membranes, loss of H+ transmembrane gradient, and uncoupling of the respiratory chain, which result in the high permeability of mitochondrial matrix, expansion of its volume, release of cytochrome C into the cytolymph, promotion of enzyme chain reactions of caspases family after the release of cytochrome C, and some apoptosis promotion factors, and ultimately cell apoptosis occurs.
Fetal and neonatal medicine
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
4.12. A 2.1 kg full-term infant becomes irritable and develops coarse tremors at 36 h of age. He feeds poorly and has diarrhoea and nasal stuffiness. Which of the following statements is/are true?The most likely diagnosis is hypoglycaemia.The most appropriate treatment for this infant is 10% calcium gluconate.The patient should be isolated.The mother should be tested for hepatitis Β antigen.The infant is at risk of developing hyperpyrexia.
Pediatric emergency revisits of children with COVID-19
Published in Postgraduate Medicine, 2023
Leman Akcan Yildiz, Oznur Karaca Vural, Ali Kansu Tehci, Halise Akca, Funda Kurt, Ayla Akca Caglar, Emine Dibek Misirlioglu
The patients meeting these criteria were acquired from the hospital’s electronic medical records (EMR), and the EMR for each patient was reviewed by the researchers. Data on demographics (age, sex), clinical information (complaints at presentation, duration of complaints, underlying chronic diseases, physical examination findings), laboratory and radiological test results, treatments, hospitalization, and clinical course and outcomes (hospitalization, intensive care admission, death, etc.) were obtained from EMR. COVID-19 severity was classified as asymptomatic, mild, moderate, severe, and critical according to the classification of the World Health Organization [9]. Fever is defined as tympanic body temperature higher than 38.0°C; hypoxia is defined as pulse oximeter saturation lower than %92. Tachycardia and tachypnea are determined by normal vital signs ranges for children age groups.
Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement
Published in The World Journal of Biological Psychiatry, 2018
Seetal Dodd, Philip B. Mitchell, Michael Bauer, Lakshmi Yatham, Allan H. Young, Sidney H. Kennedy, Lana Williams, Trisha Suppes, Carlos Lopez Jaramillo, Madhukar H. Trivedi, Maurizio Fava, A. John Rush, Roger S. McIntyre, Michael E. Thase, Raymond W. Lam, Emanuel Severus, Siegfried Kasper, Michael Berk
Serotonin syndrome is the possible result of excessive serotonin receptor antagonism and not necessarily an idiopathic drug reaction (Boyer and Shannon 2005). Serotonin syndrome is diagnosed by clinical symptoms suggestive of CNS hyper-excitability co-occurring with drug-induced increased serotonin. Symptoms vary between cases and may be mild to life threatening. Common symptoms include; confusion, consciousness impairment, agitation, tremor, hyperreflexia, myoclonus, tachycardia, hypertension and fever. In more severe cases rhabdomyolysis, clonus, rigidity/hypertonicity, elevated temperature, fever or hyperthermia may be evident (Werneke et al. 2016). Treatment of serotonin syndrome requires stopping the serotonergic agent in all cases. Intensity of treatment depends on the severity of illness however, treating clinicians should be aware that some cases may deteriorate without aggressive management. Cardiorespiratory and thermal abnormalities must be aggressively corrected (Boyer and Shannon 2005). Cyproheptadine is a recommended therapy, although other agents have been used (Boyer and Shannon 2005).
Thyroid storm secondary to acute Streptococcus pyogenes pharyngitis
Published in Baylor University Medical Center Proceedings, 2022
Valeria Hanson, Subaina Naeem Khalid, Glenn Ratmeyer, Abu Baker Sheikh
The diagnosis of thyroid storm is based on clinical suspicion. The Burch-Wartofsky scale and the Japanese Thyroid Association scale are the point system methods that assess dysfunctional changes in the thermoregulatory, central nervous system, cardiovascular, and gastrointestinal-hepatic systems.5,7 Classical symptoms include hyperpyrexia with diaphoresis and tachyarrhythmias, which coincide with our patient's presentation, including elevated brain natriuretic peptide and liver function test levels that correspond with heart failure and liver dysfunction, respectively. Infection is deemed a significant trigger for developing thyrotoxicosis; however, the type of infectious organism is still unknown. Previous case reports suggest links with a few upper respiratory tract infections (H1N1, COVID-19, SARS-COV-2) with the onset of thyroid storm; however, literature is sparse.8–10
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