Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For relief from cancer pain, we developed critical pathway (CP) as an effective strategy for the medical staff treating cancer patients. This CP was made out of Microsoft Excel, and was used on personal computers. "Good sleeping" was set as the first goal and the second was "No pain in rest position." To achieve this, physicians and nurses evaluate medical efficacy and complications including nausea/vomiting, constipation, somnolence and hallucination everyday using controlled release oxycodone in addition to NSAIDs and prochlorperazine, stool softener and peristaltic stimulant for adverse effects. These outcomes lead to the medication change the next day by calculation using visual basic function due to opioid titration theory. In twelve patients this CP was acceptable, and all of them achieved the second goal within a week without severe adverse effects except constipation.
 ...
PMID:[Pain management for cancer patients with critical pathway on computer]. 1575 27

Psychiatric manifestations of cerebral malaria have been described for a while. The purpose of this study was conducted to describe this type of clinical manifestations of malaria among inpatients admitted at the psychiatric department in Dakar, Senegal from 1998 to 1999 (2 years) based on personnal observations. During this period. 1 male and 3 females, 13 to 22 years old, presented psychiatric disorders represented by mental confusion, delirium syndrom with zoopsia, visual hallucinations, motor agitation associated to other malarial clinical features: fever, headache, shiver, sweating and belious vomiting. All the patients were smear blood positive to Plasmodium falciparum with a parasiteamia between 2524 to 61500 parasites per ml. No psychiatric history was noted among them. Antimalarial treatment was used associated either with neuroleptic or tranquilliser. All of them recovered after 12 to 31 days of hospitalization (mean lengh of slay = 20 days). Psychotropic treatment was stopped after 15 days and no relapse was observed after 1 year of follow-up. The autors focus on the importance of psychiatric manifestations of cerebral malaria especially in endemic area like Senegal. They also insist on the possiblities of misdiagnosis and though a delay for an early and effective management.
 ...
PMID:[Mental disorders in cerebral malaria]. 1577 59

Single-shot "kiddie caudal" with bupivacaine alone is losing popularity because of its duration of 4-8 h. In a prospective randomized double-blind clinical study, we assessed and compared the efficacy of ketamine, midazolam, and neostigmine coadministered with bupivacaine in a caudal epidural to provide intraoperative and postoperative pain relief. Eighty children (ASA status I) aged 5-10 yr undergoing unilateral inguinal herniotomy were allocated randomly in equal numbers (n = 20) into 4 groups to receive a caudal injection of 0.25% bupivacaine (1 mL/kg) with or without ketamine (0.5 mg/kg), midazolam (50 microg/kg), and neostig-mine (2 microg/kg), after the induction of standardized general anesthesia without premedication. Monitoring for pain, sedation, postoperative nausea/vomiting, dizziness, and pruritus was performed by anesthesiologists blinded to the study allocation. The time to first analgesic administration (paracetamol syrup) was longer (P < 0.05) in the bupivacaine-neostigmine group and the bupivacaine-midazolam group than in the other groups. Undesirable effects, such as emesis, pruritus, and dizziness, were comparable in all groups. However, the incidence of hallucination was more frequent in the bupivacaine-ketamine group compared with the other groups. This study shows that single-shot caudal coadministration of bupivacaine-neostigmine and bupivacaine-midazolam was associated with an extended duration of postoperative pain relief.
 ...
PMID:Caudal additives in pediatrics: a comparison among midazolam, ketamine, and neostigmine coadministered with bupivacaine. 1652

2,5-Dimethoxy-4-bromoamphetamine (DOB) is a strongly acting hallucinogen with an estimated effective dose of 2 mg for an 80 kg man. The case of two men who ingested a new "hallucinogen LSD-like" designer drug is reported here. They experienced intense hallucinations (onset after 15 min) and vomiting. The men became unconscious and fell into deep coma lasting several days. After an unknown period of time elapsed they were admitted to a hospital in a comatose state. One subject (AX, body mass 113 kg) survived, while the second subject (BX, body mass 65 kg) experienced convulsions, metabolic acidosis and died 6 days later. Gastric, blood, and urine specimens collected on admission into the hospital were sent for toxicological examination. Ethanol concentrations in the blood samples were less than 0.2 g/kg. CEDIA urine screening indicated the presence of THCOOH in both cases, while cocaine and its metabolites were only indicated in the urine from AX. Immunoassay for amphetamines was negative in urine specimens collected from both subjects. GC-MS analysis for unknown drugs allowed for the discovery of the presence of DOB in the gastric and urine samples of both persons. DOB-targeted analysis for the acetylated analyte confirmed its presence in both subjects. Quantitative analysis yielded concentrations in serum of 13 ng/ml (AX) and 19 ng/ml (BX). This report on both nonfatal and fatal DOB overdose cases is based on clear toxicological evidence, and is the first documentation of DOB consumption in the Czech Republic.
 ...
PMID:Nonfatal and fatal DOB (2,5-dimethoxy-4-bromoamphetamine) overdose. 1597 34

In order to improve diagnosis of schizophrenia with onset in adolescents at an early stage, we investigated in detail the clinical features of 74 patients with schizophrenia, (23 males) at adolescents psychiatric clinic. Many of the subjects had been suffering from the illness about 14 years old but had not undergone their first psychiatric examination until a few years later. A high percentage (more than 80%) of our subjects presented psychiatric symptoms such as delusional remembrance, delusional moods, delusions of persecution and hypobulia. Additionally, more than 60% of our subjects presented auditory hallucinations. In general, teenage patients with schizophrenia onset show vague symptoms such as anxiety, embarrassment and strange moods rather than obvious hallucinations. Nevertheless, it was possible to identify certain clinical features of this disorder in adolescents: many patients suffer delusional remembrance, delusional moods and delusions of persecution immediately after the onset of the illness. Gradually, problematic behaviors such as anorexia, self injury, offences against their families, voluntary vomiting, etc., develop, but patients do not always receive psychiatric examination at this stage. After socially obvious problems such as school refusal, withdrawal from social activities and lowering of school record develop over a period of time, patients may be urged to undergo psychiatric examination. Our research again underlines the difficulty of achieving diagnosis of schizophrenia at an early stage. The key to early diagnosis appears to be the accurate identification of psychiatric symptoms in the early stages of the illness at school, or at home if possible, before socially problematic behaviors arise.
 ...
PMID:[Relationship between the courses of clinical Features of patients with schizophrenia in adolescents and admission to psychiatric clinic]. 1638 83

Recently there has been a resurgence in the utilization of ketamine, a unique anaesthetic, for emergency procedures requiring sedation. The purpose of the present study was to examine the safety and efficacy of ketamine for sedation in the treatment of children's fractures in the small clinic setup of rural Nepal. One hundred and fourteen children (average age, 5.3 years; range, twelve months to ten years and ten months) who underwent closed reduction of an isolated fracture or dislocation in the Orthopaedic & Trauma Clinic at Janakpurdham were prospectively evaluated. Ketamine hydrochloride was administered intravenously (at a dose of less than two milligrams per kilogram of body weight) in ninety-nine of the patients and intramuscularly (at a dose of four milligrams per kilogram of body weight) in the other fifteen. Adequate fracture reduction was obtained in 111 of the children. Ninety-nine percent (sixty-eight) of the sixty-nine parents present during the reduction were pleased with the sedation and would allow it to be used again in a similar situation. Minor side effects included nausea (thirteen patients), emesis (eight of the thirteen patients with nausea), clumsiness (evident as ataxic movements in ten patients), and dysphonic reaction (one patient). No long-term sequelae were noted, and no patients had hallucinations or nightmares. Ketamine reliably, safely, and quickly provided adequate sedation to effectively facilitate the reduction of children's fractures at our institution. Therefore, it was ideal for small clinic in our setup.
 ...
PMID:Sedation with ketamine: a safe and effective anaesthetic agent for children in the developing world. 1658 65

In 2003, there were 28,092 human exposures to diphenhydramine reported to poison centers in the US. A related drug, dimenhydrinate, is a less frequent cause of poisonings. Between January 2000 and June 2004, there were 2,534 reported dimenhydrinate ingestions in children less than 6 years of age. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. The first draft was created by the primary author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of diphenhydramine or dimenhydrinate, or a dermal exposure to diphenhydramine. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. The panel's recommendations for dermal or oral exposures to diphenhydramine or oral exposures to dimenhydrinate follow. The grade of recommendation is in parentheses: 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department (Grade D). 2) In patients without evidence of self-harm, abuse, or malicious intent, poison center personnel should elicit additional information including the time of the ingestion or dermal exposure, determination of the precise dose ingested, and the presence of co-ingestants (Grade D). 3) Patients experiencing any changes in behavior other than mild drowsiness or mild stimulation should be referred to an emergency department. Examples of moderate to severe symptoms that warrant referral include agitation, staring spells, inconsolable crying, hallucinations, abnormal muscle movements, loss of consciousness, seizures, or respiratory depression (Grade D). 4) For patients referred to the emergency department, transportation via ambulance should be considered based on several factors including the condition of the patient and the length of time it will take the patient to arrive at the emergency department (Grade D). 5) If the patient has no symptoms, and more than 4 hours have elapsed between the time of diphenhydramine ingestion and the call to the poison center, referral to an emergency department is not recommended. For dermal exposures to diphenhydramine, if the patient has no symptoms and it has been more than 8 hours since the diphenhydramine was thoroughly removed from the skin, referral to an emergency department is not recommended (Grade D). 6) Patients with acute ingestions of less than a toxic dose of diphenhydramine, or chronic exposures to diphenhydramine and no or mild symptoms, can be observed at home with instructions to call the poison center back if symptoms develop or worsen. The poison center should consider making a follow-up call at approximately 4 hours after ingestion (Grade D). 7) Children less than 6 years of age who ingest at least 7.5 mg/kg of diphenhydramine should be referred to an emergency department (Grade D). 8) Patients 6 years of age and older who ingest at least 7.5 mg/kg or 300 mg of diphenhydramine (whichever is less), should be referred to an emergency department (Grade D). 9) If the patient has no symptoms, and more than 6 hours have elapsed between the time of dimenhydrinate ingestion and the call to the poison center, referral to an emergency department is not recommended (Grade D). 10) Patients with acute ingestions of less than a toxic dose of dimenhydrinate, or chronic exposures to dimenhydrinate and no or mild symptoms, can be observed at home with instructions to call the poison center back if symptoms develop or worsen. The poison center should consider making a follow-up call at approximately 6 hours after ingestion (Grade D). 11) Children less than 6 years of age ingesting at least 7.5 mg/kg of dimenhydrinate should be referred to an emergency department (Grade D). 12) Patients 6 years of age and older ingesting at least 7.5 mg/kg or 300 mg of dimenhydrinate (whichever is less), should be referred to an emergency department for evaluation (Grade D). 13) Following oral exposures of diphenhydramine or dimenhydrinate, do not induce emesis. Because of the potential for diphenhydramine or dimenhydrinate to cause loss of consciousness or seizures, activated charcoal should not be administered en route to an emergency department (Grade D). 14) For chronic dermal exposures of diphenhydramine, skin decontamination (with water or soap and water) should be attempted prior to transporting a patient to an emergency department unless moderate to severe symptoms are already present. In this circumstance, transportation should not be delayed, and EMS personnel should attempt skin decontamination en route to the emergency department (Grade D). 15) Intravenous sodium bicarbonate may be administered by EMS personnel if QRS widening (QRS >0.10 msec) is present and if authorized by EMS medical direction (Grade D). 16) Physostigmine should be reserved for administration in a hospital (Grade D). 17) Benzodiazepines may be administered by EMS personnel if agitation or seizures are present, and if authorized by EMS medical direction (Grade D).
 ...
PMID:Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management. 1674 37

This case report draws attention to the dramatic consequences of the consumption of Angel's Trumpet. Angel's Trumpet contains alkaloids (especially scopolamine, as well as hyoscyamine, atropine and other alkaloids) in a relatively high concentration. When intoxicated with Angel's Trumpet, patients can suffer hallucinations, motoric restlessness, overtalkativeness, convulsive sobbing and sexual excitement, as well as aggressive and autoaggressive behaviour. Somatic symptoms are tachycardia, mydriasis, hypertonia, respiratory disturbances and vomiting, as well as a potentially life-threatening anticholinerg syndrome. In this paper, we report on a young man who amputated his penis and his tongue after having consumed Angel's Trumpet tea, illustrating that consuming this beautiful flower with the name of an angel and the poison of the devil can be very dangerous.
 ...
PMID:Self-amputation of penis and tongue after use of Angel's Trumpet. 1678 91

Zolpidem and zaleplon are used for the treatment of insomnia. The objective of this study was to compare the patterns of zolpidem and zaleplon exposures reported to Texas poison control centers during 1998-2004. There were 5842 total reported zolpidem exposures, of which 2918 (50%) were isolated exposures, and 467 total reported zaleplon exposures, of which 201 (43%) were isolated exposures. Zolpidem patients were 62% male and 67% adult. Zaleplon patients were 67% male and 34% adult. The exposure was intentional in 62% of zolpidem and 58% of zaleplon exposures. The exposure occurred at the patient's own residence in 94% of zolpidem and 97% of zaleplon exposures. Management occurred outside of a health care facility for 29% of zolpidem and 32% of zaleplon exposures. The medical outcome involved no symptoms due to exposure for 29% of zolpidem and 44% of zaleplon exposures, a statistically significant difference. Although many of the most frequently reported adverse clinical effects for the two drugs were similar (drowsiness, slurred speech, hallucinations, ataxia, tachycardia, dizziness, confusion, vomiting), the proportion of exposures with a given adverse clinical effect was generally lower for zaleplon. Thus, although zolpidem and zaleplon exposures were generally similar with respect to patient gender and age, exposure reason and site, and management site, zaleplon exposures were less likely to result in minor medical outcomes or manifest as adverse clinical effects.
 ...
PMID:Comparison of zolpidem and zaleplon exposures in Texas, 1998-2004. 1695 7

Hyponatraemia is a very rare but potentially fatal complication of SSRIs and citalopram therapy, especially during the first weeks of treatment and for those who concomitantly use medications known to cause hyponatraemia. We present a 54-year-old hypertensive female patient who was admitted to the hospital with drowsiness, paresthesia, fatigue, nausea, vomiting and visual hallucinations and who was diagnosed to have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to citalopram. All her presenting symptoms disappeared after discontinuation of citalopram therapy, fluid restriction and a careful hypertonic saline infusion. This case suggests that SIADH may develop among hypertensive patients, especially when they use diuretics or follow a salt restricted diet.
 ...
PMID:Citalopram-induced SIADH in a hypertensive patient on salt restricted diet. 1709 60


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>