An Overdose that Happens Hours Later

​A 15-year-old girl was brought to the emergency department by EMS after a seizure witnessed by her mother. She admitted that she had ingested "a handful of pills" in a suicide attempt five hours earlier. The mother said her daughter had a history of cutting but no prior suicide attempts.Her past medical history was significant for depression, for which she took bupropion XL, and she reported past alcohol and marijuana use. Her initial vital signs were a temperature of 97.9°F, a pulse of 162 bpm, a blood pressure of 127/65 mm Hg, a respiratory rate of 14 bpm, and a pulse ox of 100% on room air. Her exam was significant for altered mental status, and she appeared post-ictal.The patient had no focal neurologic deficits. Her heart rate was tachycardic, and she had no muscle rigidity, hyperreflexia, or myoclonus. Her ECG demonstrated a sinus tachycardia with a normal QRS but a QTc of 509 ms. She had another seizure while in the ED, and was given 1 mg lorazepam IV. The seizure then stopped.She continued to have seizures despite frequent administration of lorazepam, and after her third episode, she was sedated with propofol and intubated. The patient was given multiple amps of bicarb, which had minimal effect on the QTc. The patient was transferred to the PICU.The Mechanism of BupropionBupropion is a monocyclic antidepressant structurally similar to amphetamines. It is a selective inhibitor of dopamine, serotonin, and norepinephrine reuptake. Bupropion also exerts a...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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Publication date: Available online 25 January 2020Source: British Journal of Oral and Maxillofacial SurgeryAuthor(s): H. Saghafi, P. Benington, A. AyoubAbstractThe aim of this study was to compare the impact that the orthodontics-first approach and the surgery-first approach have on quality of life, anxiety, and depression in patients treated for dentofacial deformities. Data were collected on 32 patients (aged 17–47 years) who were all treated at a single multidisciplinary orthognathic clinic. They completed a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), a seven-item Generalised Anxiety Disorder (GAD-7...
Source: British Journal of Oral and Maxillofacial Surgery - Category: ENT & OMF Source Type: research
Publication date: Available online 25 January 2020Source: Pharmacology &TherapeuticsAuthor(s): Yun-Feng LiAbstractMajor depressive disorder has become a global public health problem of serious concern. Most of the clinical antidepressants are developed under the classic “monoamine hypothesis (strategy)”. These drugs generally have such deficiencies including slow onset and limited efficiency, cognitive impairment and suicidal tendency. Therefore, it is the direction to break through the classic monoamine strategy framework for developing antidepressants that have fast-acting, lower side effects, and cogniti...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
ConclusionP. karwinskii leaf extract inhibited reactive oxygen species and exerted an anti-inflammatory effect. Moreover, this extract did not induce gastric damage in the animals. The bioactivity of the species was found to support its traditional use in traditional medicine. This orchid could be used to treat inflammatory diseases without causing the side effects associated with Nonsteroidal anti-inflammatory drugs. It can also be employed to treat other pathological conditions associated with oxidative stress. The findings herein form the basis for the future discovery of natural products that may serve as safe alternat...
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsThe results suggested that KXS exerted antidepressant effects by regulating the signaling pathways involved in lipid metabolism disorders. The lipid metabolites might be potential biomarkers of depression and possible targets for KXS-based treatment of depression.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
This study aims to explore the relationship between miR-195 and CD40 and its effect on Th17/Treg balance in rats with non-alcoholic fatty liver disease (NAFLD).MethodsWe established rat models of NAFLD and made seven groups, Normal group (without modeling), Model group (model rats), NC group (model rats injected with negative control vector), miR-195 OE group (model rats injected with miR-195 mimic), anti-miR-195 group (model rats injected with miR-195 inhibitor), Si-CD40 group (model rats injected with CD40 silencing vector), and anti-miR-195+Si-CD40 group (model rats injected with miR-195 inhibitor and CD40 silencing vec...
Source: Biomedicine and Pharmacotherapy - Category: Drugs & Pharmacology Source Type: research
ConclusionsCMR is a key tool for diagnosing LDAC. Characteristic findings are subepicardial fatty infiltration and midwall-subepicardial late gadolinium enhancement. The prognosis of this population is poor with a high incidence of sudden cardiac death and ventricular arrhythmias.ResumenIntroducción y objetivosRecientemente, la miocardiopatía arritmogénica del ventrículo izquierdo (MCAVI) ha sido reconocida como parte del espectro de la miocardiopatía arritmogénica. Se caracteriza por el reemplazo fibroadiposo de la pared de dicho ventrículo. Se describen las formas de prese...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
Publication date: Available online 25 January 2020Source: Materials LettersAuthor(s): Nan He, Xinwei Liu, Fei Gao, Qiangqiang Zhang, Miaocheng Zhang, Yu Wang, Xinyi Shen, Xiang Wan, Xiaojuan Lian, Ertao Hu, Lin He, Jianguang Xu, Yi TongAbstractAs the emerging device for neuromorphic applications, memristive device is arguable regarded as the most promising candidate to emulate biological synapse due to its specific analog behaviors and various plasticities. Nevertheless, the stability of memristive device remains an extreme challenge limiting its practical applications. In this work, two-dimensional (2D) material MXene is ...
Source: Materials Letters - Category: Materials Science Source Type: research
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Source: Journal of Mental Health - Category: Psychiatry Authors: Source Type: research
In this study, we examined the clinical and psychosocial characteristics of youth at familial and clinical high risk (HR) for BD, and compared these characteristics to those of youth with BD I and II. Both groups were recruited based on current, active mood symptoms from separate randomized trials of family therapy. A total of 127 HR youth were evaluated: 52 (40.9%) were diagnosed with BD-NOS and 75 (59.1%) were diagnosed with MDD. Compared to adolescents with BD I and II (n=145), HR youth had higher rates of anxiety disorders, and comparable rates of attention-deficit/hyperactivity disorder and oppositional defiant disord...
Source: Journal of Psychiatric Research - Category: Psychiatry Source Type: research
CONCLUSIONS: Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment. PMID: 31973775 [PubMed - in process]
Source: Epidemiology and Psychiatric Sciences - Category: Psychiatry Tags: Epidemiol Psychiatr Sci Source Type: research
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