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

Poisoning is a significant problem in the elderly. The majority of poisonings in older people are unintentional and may result from dementia and confusion, improper use of the product, improper storage or mistaken identities. Depression is also common in the elderly and suicide attempts are more likely to be successful in this age group. The elderly patient's recuperative abilities may be inadequate as a result of numerous factors including impaired hepatic or renal function as well as chronic disease processes. General management of poisoning in the elderly parallels management of younger adults, but it is especially important to ascertain underlying medical conditions and concurrent medications. In most poisonings, activated charcoal and cathartic are sufficient. Haemodialysis or haemoperfusion may be required at lower plasma drug concentrations in elderly patients. While the specific indications for antidotes are the same for all age groups, dosage alterations and precautions may need to be considered in the elderly. Drugs most often implicated in poisonings in the elderly include psychotherapeutic drugs, cardiovascular drugs, analgesics and anti-inflammatory drugs, oral hypoglycaemics and theophylline. Cardiovascular and neurological toxicities occur with overdoses of neuroleptic drugs and, more frequently and severely, with cyclic antidepressants. Patients with pre-existing cardiovascular disease are at particular risk of worsening ischaemic heart disease and congestive heart failure. Benzodiazepines only appear to produce significant toxicity during long term administration or in combination with other CNS depressants. Digoxin can cause both chronic and acute intoxication, most seriously cardiac toxicity including severe ventricular arrhythmias, second or third degree heart block or severe refractory hyperkalaemia. Immune Fab antibody is indicated for the management of digoxin toxicity, although patients dependent on the inotropic effect of digoxin may develop heart failure after digoxin Fab antibody administration. Nitrates can cause toxicity including headache, vomiting, hypotension and tachycardia from excessive sublingual, transdermal or intravenous doses. Conduction disturbances and hypotension occur with overdoses of antihypertensive drugs; these effects are mild with angiotensin converting enzyme (ACE) inhibitors, occasionally severe with beta-blockers and of significant concern with calcium channel antagonists. The elderly commonly use aspirin and other salicylates, are more likely to develop chronic intoxications to these agents, and are more susceptible to severe complications such as pulmonary oedema. Salicylate poisoning, recognition of which is often delayed, should be considered in elderly patients with neurological abnormalities or breathing difficulties, especially in the setting of acid-base abnormalities. The clinical effects of NSAID overdose are mild and usually involve the central nervous system and gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Poisoning in the elderly. Epidemiological, clinical and management considerations. 179 7

The efficacy of both the emetic syrup prepared in the previous report and the United States Pharmacopoeia (USP) ipecac syrup concerning the prevention of drug absorption was investigated in 4 beagle dogs using a randomized and cross-over design. In order to control the intragastric pH of the beagle dogs, the administration of pentagastrin or hydrochloric acid (HCl)-glycine buffer (pH 1.5) was tested. The intragastric pH changed from 7.2 to 1.8 with the intramuscular administration of pentagastrin, but the primary emesis occurred more slowly. On the other hand, the HCl-glycine buffer (pH 1.5) gave the appropriate emesis. Therefore, the HCl-glycine buffer (pH 1.5) was used to control the intragastric pH of the beagle dogs. Acetaminophen (AcA), salicylic acid (SA) and kanamycin (KM) as markers were administered orally after conditioning the intragastric pH at 1.5. The emetic syrup or the USP ipecac syrup was then administered. The recovery rate of AcA and KM from vomit was 42-65%. The emetic syrup and the USP ipecac syrup significantly reduced the absorption of AcA from the calculation of pharmacokinetic parameters compared to the control syrup. It was observed that the absorption of cephaeline (CP) in the emetic syrup was less than that of CP in the USP ipecac syrup.
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PMID:Efficacy of emetic and United State pharmacopoeia ipecac syrup in prevention of drug absorption. 198 Jun 39

The effect of repeated doses of 1.8 g lysine acetyl salicylic acid (LAS) i.v. on severe pain secondary to acute renal colic (ARC) was studied in 45 consecutive patients. Clinically acceptable analgesia was obtained in 65% of the cases. No additional pain relief was achieved with the combination of pethidine 100 mg i.v. + metoclopramide 10 mg, i.m. (narcotics). Pain relief occurred within five minutes in one third of the patients while in the rest within 30 minutes. Significant reduction of systolic blood pressure (mean +/- S.D.) 23.8 +/- 19.5, pulse rate (mean +/- S.D.) 19.5 +/- 10.1 and vomiting were noted in patients who had pain relief. The incidence of nausea has increased after LAS administration. No other side effects were observed. LAS might therefore be applied as a first-hand alternative to narcotics for the treatment of ARC.
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PMID:Lysine acetyl salicylic acid in acute renal pain. 250 91

A case of multiple intracerebral tuberculoma occurred in the course of anti-tuberculous therapy is reported. A 16-year-old high school boy had been treated with isoniagid, streptomycin and paramino-salicylic acid on the tuberculous pleulitis for 3 months previously. He was admitted to our hospital because of progressive headache associated with vomiting. Neurological examination revealed bilateral full papilledema and incomplete bilateral abducens palsy. An immediate CT study with contrast enhancement demonstrated two small ring-like mass with considerable perifocal edema in the left temporal and occipital lobe, respectively. Intracerebral tuberculoma was considered to be most likely, so the patient was given antituberculous therapy with steroid and mannitol. However, despite of medical decompression, he developed intracranial hypertension aggravated, leading to removal of tumor 7 days after admission. Initially left temporal tuberculoma, which had more extensive and prominent perifocal edema, was successfully excised. The specimen was a walnut-sized granuloma with hard capsule including pus inside. Numerous tuberculous bacilli were identified with Ziel-Nielsen staining technique from the pus. Postoperative course was gratifying, and other tumor in the left occipital lobe, which was also diagnosed as tuberculoma, was treated with continuing administration of isoniagid, ethanbutol and rifampicin. However, the former two drugs were forced to be discontinued because of agranulocytosis. Only rifampicin was maintained for 2 months thereafter but no decrease of the size was observed in serial CT studies. Then left occipital tuberculoma was removed. The pathology was tuberculoma with positive bacilli staining. He discharged 1 month later without any neurological deficit but was on antituberculous therapy (rifampisin) as an outpatient for 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case report of intracerebral tuberculoma during antituberculous therapy]. 406 12

Salicylate intoxication remains a common problem in Britain; about 10 percent of adult hospital admissions for deliberate self-poisoning involve these drugs. Accidental salicylate poisoning in children has been considerably reduced since the introduction of child-resistant containers. In the United Kingdom, the annual number of salicylate-related deaths has fallen slightly between 1967 and 1980. Diagnosis of salicylate intoxication is made from patient history, circumstantial evidence, and common clinical features (tinnitus, deafness, sweating, hyperventilation), and is confirmed by measurement of the plasma salicylate concentration. Gastric emptying by lavage or emesis is an important part of the management of acute overdose. About 20 percent of adults require forced alkaline diuresis to enhance elimination of salicylate from the body. Hemodialysis and hemoperfusion are seldom indicated. The mortality rate from acute salicylate poisoning in hospital-treated adults is about one percent; death is usually preceded by neurologic features and a dominant metabolic acidosis. Chronic salicylate intoxication may follow the administration of oral therapeutic doses or the use of ointments containing acetylsalicylic acid since metabolic pathways (mainly conjugation with glycine and glucuronic acid) are readily saturated. The incidence of chronic therapeutic intoxication is unknown but appears low and is usually encountered in young children and the elderly. Diagnosis is frequently delayed because of a low index of suspicion, which in turn delays treatment and increases morbidity and mortality rates.
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PMID:Toxicity of salicylates. 665 May 33

Allergic reactions to food colors have been known since 1958. Reactions to tartrazine, our example, include generalized pruritus, urticaria, angioedema, paresthesias, vomiting, migraine, rhinorrhea and nasal obstruction, coughing, asthma attacks and purpura. Many patients who are allergic to antiinflammatory drugs such as acetyl-salicylic acid and indomethacin show cross-reaction to tartrazine. Doses producing these reactions range from minimal amounts up to 750 mg. Symptoms appear after periods of time ranging from minutes to 6 to 14 hours. In view of these facts (some of which represent a threat to the patient's life), additives, colouring matter, etc, do not usually appear in product labels or specifications, or in handbooks or catalogues used in practice. We drew up a list of drugs which may contain food dyes and coloring matter, yellow No. 5. A letter was written to 233 laboratories of which 159 (68%) replied. 72 (45%) in the affirmative and 87 (55%) in the negative, 74 (32%) did not reply.
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PMID:[Pharmaceutical preparations which contain tartrazine]. 725 46

Salicylate poisoning remains a major clinical hazard, usually resulting from accidental ingestions in preschool children, suicidal overdoses in adults and teenagers, and therapeutically acquired intoxication in all ages. Alkalemia or acidemia, alkaluria or aciduria, hypoglycemia or hyperglycemia, and water and electrolyte imbalances may occur; nausea, vomiting, tinnitus, hyperpnea, hyperpyrexia, disorientation, coma, and/or convulsions are common. With chronic, therapeutically induced salicylism, these symptoms may be mistaken for symptoms resulting from the illness for which the salicylates were administered. For acute ingestions, the magnitude of the poisoning is clearly dose related. Blood level determinations are good prognostic indicators for acute ingestions but are of limited value in chronic, therapeutically induced salicylism. Fluid and electrolyte management is the mainstay of therapy. Diuresis, hemodialysis, and hemoperfusion are effective, but the latter two rarely are necessary.
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PMID:Acute and chronic effects of aspirin toxicity and their treatment. 746 27

A controlled investigation was undertaken to compare topical lignocaine and rectal paracetamol in the prevention of pain after day case dental extraction in children under general anaesthesia. Sixty patients were allocated randomly to receive intraoperatively either topical lignocaine 4 mg/kg (group A), rectal paracetamol 10 mg/kg (group B) or no analgesia (group C) immediately after completion of surgery. Pain, appearance and side-effects were assessed 15, 30 and 60 minutes postoperatively. The patients who received topical lignocaine (group A) had significantly lower pain scores at 15 minutes (p < 0.001) and 30 minutes (p < 0.01) with no need for postoperative analgesia. The use of topical lignocaine was associated with a significantly (p < 0.01) more rapid return to a calm awake appearance at 15 and 30 minutes postoperatively. Patients in group C who received no analgesia at the end of the operation received 10 mg/kg acetyl salicylic acid intramuscularly after their return to the ward. No significant differences in the incidence of nausea, vomiting, or any other toxic reaction were found between the three groups. The improved analgesia and shorter recovery period topical lignocaine render it more satisfactory for the prevention of pain after day dental extraction in children than the more commonly used rectal paracetamol.
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PMID:Painless dental extraction in children. 821 65

Aspirin, Neem oil, valproic, adipic, benzoic, isovaleric, 3-mercaptopropionic and 4-pentenoic acids are implicated in the pathogenesis of Reye's syndrome, Jamaican vomiting sickness, and related chemical toxicities. These disorders are characterized by hyperammonemia, hypoglycemia, microvesicular steatosis and encephalopathy. The goal of this study was to determine whether chemicals implicated in Reye's-related disorders induce the mitochondrial permeability translation (MPT). The MPT is induced by opening of a high-conductance, cyclosporin-sensitive pore in the mitochondrial inner membrane, causing swelling, depolarization and uncoupling of oxidative phosphorylation. In freshly isolated rat liver mitochondria, unhydrolyzed aspirin (300 microM) did not induce the MPT in the presence of 50 microM CaCl2. Salicylate, the hydrolysis product of aspirin and its active metabolite, was much more potent causing dose-dependent onset of the MPT in a therapeutic range of concentrations (37.5-300 microM). Similarly, Neem oil and valproic, adipic, benzoic, isovaleric, 3-mercaptopropionic and 4-pentenoic acids induced onset of the MPT. In all cases, cyclosporin A (200 nM), a specific inhibitor of the permeability transition pore, blocked the MPT caused by these inducers. Induction of the MPT by these agents was not caused by mitochondrial depolarization because concentrations of valproic acid and salicylate inducing the MPT had little effect on mitochondrial delta psi. Moreover, equivalent uncoupling caused by 5 nM carbonyl cyanide p-trifluoromethoxyphenylhydrazone did not induce an MPT. These data suggest that induction of the MPT is a common pathophysiological mechanism causing mitochondrial injury in Reye's syndrome and Reye's-related drug toxicities.
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PMID:The mitochondrial permeability transition: a new pathophysiological mechanism for Reye's syndrome and toxic liver injury. 881 78

1. A total of 512 consecutive paediatric hospital admissions of children 2 years old or less were evaluated to assess the extent and pattern of admission caused by suspected adverse drug reactions (ADRs). the proportion of suspected ADRs related to hospital admissions was 4.3%. 2. The organ-systems most commonly implicated were the central nervous system (40.5%), digestive system (16.7%), and skin and appendages (14.3%). Together, they accounted for 71.5% of admissions attributed to ADRs. The most common clinical manifestations inducing admission were convulsions (4 cases), dizziness (4), vomiting (3), and tremor, fever, itching and apnoea (2 cases each). 3. The four classes of drugs most frequently suspected in admissions due to ADRs were respiratory drugs (35%), anti-infective agents (25%), drugs active on the central nervous system (15%) and drugs used in dermatology (10%). The most common drugs related to ADRs were a combination of chlorpheniramine, diphenhydramine, phenylephrine, guaiphenesin and salicylic acid (4 cases), followed by fenoterol, adrenaline, paracetamol, DTP vaccine and antipolio vaccine (2 cases each). 4. There were no significant differences between children older and younger than 1 year (odds ratio 0.89; 95% CI 0.37-2.17) or between the sexes as regards hospital admittance due to suspected ADRs (odds ratio 1.94; 95% CI 0.72-5.42). 5. The results of this kind of study may be influenced by patterns of drug utilization. Nevertheless, the lack of specific studies of drug effects in young children makes it desirable to carry out pharmacoepidemiological studies in this age group.
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PMID:A prospective study of adverse drug reactions as a cause of admission to a paediatric hospital. 887 22


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