Ann Pharmacother 2001 Jun;35(6):785-6
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PMID: 11409002, UI: 21302575
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Ann Pharmacother 2001 Jun;35(6):784-5
PMID: 11409001, UI: 21302574
Ann Pharmacother 2001 Jun;35(6):698-701
GV (Sonny) Montgomery Veterans Administration Medical Center, USA. roy.reeves2@med.va.gov
OBJECTIVE: To report a case of neuroleptic malignant syndrome (NMS) in a patient whose therapy was being switched from haloperidol to risperidone. CASE REPORT: A 57-year-old African-American man, treated for schizophrenia with haloperidol for several years, developed NMS within 48 hours of the addition of low doses of risperidone and mirtazapine to his regimen. Symptoms, which included fever, generalized rigidity, and altered mental status, resolved after discontinuation of psychotropics, supportive management, and several weeks of treatment with bromocriptine and dantrolene. He was subsequently treated with olanzapine without adverse effects. DISCUSSION: Several cases of NMS have been reported with risperidone, but none under these circumstances. NMS most likely occurred in this patient as a result of the additive dopamine 2 receptor blocking of haloperidol and risperidone. Sympathetic hyperactivity secondary to mirtazapine may also have been a contributing factor. If NMS may be induced by the simultaneous use of older, high-potency antipsychotics and newer, atypical antipsychotics such as risperidone, switching patients from older to newer antipsychotics may at times be difficult, since completely stopping one antipsychotic before starting the second may place patients at risk for psychotic relapse. CONCLUSIONS: Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications.
PMID: 11408988, UI: 21302561
Ann Pharmacother 2001 Jun;35(6):694-7
St. John's University College of Pharmacy and Allied Health Professions, Jamaica, NY, USA.
OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with trimethoprim/sulfamethoxazole (TMP/SMX). CASE SUMMARY: A 34-year-old Asian woman developed a severe, desquamating mucocutaneous reaction (TEN) after six days of taking TMP/SMX to treat a presumed urinary tract infection (UTI). DISCUSSION: TMP/SMX is often recommended as first-line therapy for UTIs, sinusitis, bronchitis, and as prophylaxis and treatment for Pneumocystis carinii pneumonia. TEN is a rare, but severe condition associated with sulfonamide use. This article describes a typical case and offers an opportunity for review of this potentially serious reaction. CONCLUSIONS: Sulfonamides are often implicated in the majority of drug-induced cases of TEN. This case report illustrates the typical presentation of sulfonamide-induced TEN with a prodrome, characteristic rash, mucous membrane lesions, and systemic involvement. Practitioners should be aware of this rare adverse effect and closely observe patients for cutaneous manifestations or complaints. Any suspected drug should be discontinued if clinical evaluation leads to the suspicion of Stevens-Johnson syndrome or TEN.
PMID: 11408987, UI: 21302560
J Emerg Med 2001 Oct;21(3):289-90
Emergency Department St. John's Hospital, Jackson, Wyoming, USA
[Medline record in process]
PMID: 11604288, UI: 21490377
J Emerg Med 2001 Oct;21(3):283-4
Associate Professor of Medicine Pulmonary and Critical Care Section Baylor College of Medicine Research Director, Department of Emergency Services The Methodist Hospital, Houston, Texas, USA
PMID: 11604286, UI: 21490375
J Emerg Med 2001 Oct;21(3):249-53
Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Post-disaster carbon monoxide (CO) poisoning is a growing problem in the United States. This study describes a documented outbreak of CO poisoning associated with flooding. Health department staff investigated cases of CO poisoning following the severe flood of 1997 in Grand Forks, North Dakota. Thirty-three laboratory-confirmed cases were identified, involving 18 separate incidents. Patients ranged in age from 7 to 67 years, and most were men. One patient lost consciousness and was admitted to the hospital; all others were released after receiving supplemental oxygen. Every incident involved gasoline-powered pressure washers being used in basements. Five incidents among professional cleaners accounted for 16 cases; the remaining incidents involved noncommercial use. Thirty patients, from 15 incidents, reported the basement was ventilated while the pressure washer was in use. CO poisoning must be considered a potential hazard after major floods.
PMID: 11604279, UI: 21490368
JAMA 2001 Sep 26;286(12):1445-6
PMID: 11596606, UI: 21460027
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