Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 78 cases of accidental levothyroxine ingestion in children (less than 12 years old) with treatment limited to ipecac-induced emesis and a single oral dose of activated charcoal is presented. No patient received any form of dialysis or hemoperfusion, propylthiouracil, cholestyramine, steroids, or serial doses of oral activated charcoal. Propranolol was used in one case despite the absence of clinical manifestations of toxicity. Only four children developed symptoms, limited to modest fever (38.3 degrees C), supraventricular tachycardia (120-176 beats/min), lethargy, irritability, vomiting, diarrhea, and abdominal pain. Peak T4RIA values in three patients were 32.8, 30.0, and 26.4 micrograms/dl, respectively, and two of these patients remained asymptomatic. Initial therapy for acute levothyroxine ingestions in children can be safely limited to routine gastrointestinal decontamination. Hospitalization or prophylactic treatment with propranolol, propylthiouracil, corticosteroids, cholestyramine, or extracorporeal detoxification are unnecessary in the early asymptomatic phase.
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PMID:Levothyroxine ingestions in children: an analysis of 78 cases. 286 Sep 10

Six patients were admitted after erroneous massive intake of levothyroxine (70-1200 mg over an interval of 2-12 days). All patients developed classical symptoms of thyrotoxicosis within 3 days of the first dose; five patients presented grade II-III coma and one became stuporous (days 7-10). Two patients developed left ventricular failure and three had arrhythmias (days 8-11). Total thyroid hormone levels in serum on admission ranged 935-7728 nmol/l for T4 (TT4) and 23-399 nmol/l for T3 (TT3). All patients received treatment with hydrocortisone and Propranolol. Propylthiouracil was also given in 3 cases. Extractive techniques (charcoal haemoperfusion and/or plasmapheresis) were initiated 8-14 days after the first dose of L-T4. The plasma disappearance rate (K) of TT4 with plasmapheresis was 30 times higher, on average, than under standard medical treatment (M). Also, K of TT4 under haemoperfusion was about five times higher than K under M. K changes for TT3 were higher under haemoperfusion than under plasmapheresis. Furthermore, extractive procedures shortened the average half life of TT4, (from 106.5 +/- 44.6 to 59.7 +/- 20.2 h, p less than 0.05).
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PMID:Massive thyroxine intoxication: evaluation of plasma extraction. 355 34

A 2-year-old girl was found with an empty bottle of levothyroxine and blue coloring around her mouth. Forty tablets of 150-microg levothyroxine tablets were missing. Her 6-hour postingestion total thyroxine (T4) level was 68.1 microg/dL (normal range: 5-12 microg/dL), and her total triiodothyronine (T3) level was 472 ng/dL (normal range: 40-130 ng/dL). Serum levels of thyrotropin, T3, and T4 were then checked on days 3, 5, 7, and 10. On postingestion day 5, the child presented for follow-up with hyperthermia, vomiting, irritability, and increased lethargy. She was referred to the emergency department, where a heart rate of 220 beats per minute, a blood pressure of 130/80 mm Hg, and a temperature of 101 degrees F were recorded. She also had multiple episodes of diarrhea. The patient was treated with oral propranolol (0.8 mg/kg) every 6 hours, intravenous normal saline, and ibuprofen; all her vital signs improved. Serial T3, T4, and thyrotropin serum levels were measured. Her total T3 levels were >800, 798, 445, 446, and 98 ng/dL on days 3, 5, 6, 9, and 13, respectively. Total T4 measurement was repeated on day 13, and the concentration was found to be 11.9 microg/dL. Her thyrotropin levels remained undetectable throughout the course of treatment. The patient was discharged from the hospital after a 4-day PICU stay, in good condition, on oral propranolol 0.8 mg/kg every 8 hours. Propranolol administration was discontinued 8 days after initiation with no further tachycardia, hypertension, or hyperthermia. The child tolerated the recommended regimen.
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PMID:Thyroid storm after pediatric levothyroxine ingestion. 2064 22