Although paediatric patients frequently suffer from intoxications with atypical antipsychotics, the number of studies in young children, which have assessed the effects of acute exposure to this class of drugs, is very limited. The aim of this study was to achieve a better characterization of the acute toxicity profile in young children of the atypical antipsychotics clozapine, olanzapine, quetiapine, and risperidone. We performed a multicentre retrospective analysis of cases with atypical antipsychotics intoxication in children younger than 6 years, reported by physicians to German, Austrian, and Swiss Poisons Centres for the 9-year period between January 1, 2001 and December 31, 2009. One hundred and six cases (31 clozapine, 29 olanzapine, 12 quetiapine, and 34 risperidone) were available for analysis. Forty-seven of the children showed minor, 28 moderate, and 2 severe symptoms. Twenty-nine cases were asymptomatic. No fatalities were recorded. Symptoms predominantly involved the central nervous and cardiovascular systems. Minor reduction in vigilance (Glasgow Coma Scale score >9) (62 %) was the most frequently reported symptom, followed by miosis (12 %) and mild tachycardia (10 %). Extrapyramidal motor symptoms were observed in one case (1 %) after ingestion of risperidone. In most cases, surveillance and supportive care were sufficient to achieve a good outcome, and all children made full recovery. CONCLUSIONS: Paediatric antipsychotic exposure can result in significant poisoning; however, in most cases only minor or moderate symptoms occurred and were followed by complete recovery. Symptomatic patients should be monitored for central nervous system depression and an electrocardiogram should be obtained.

In January 2010, a 39-year-old Sri Lankan man, resident in Switzerland for 15 years, presented to the emergency department with constipation and abdominal pain from which he had suffered intermittently during the previous weeks. On physical examination, the abdomen was soft without tenderness or organomegaly. An abdominal X-ray confirmed stool retention without perforation or bowel obstruction. Laboratory testing revealed a haemoglobin level of 9.1 g dl -1 with normal indices and elevated reticulocytes.The blood film showed poikilocytosis, polychromasia, anisocytosis and basophilic stippling (Figure 1). Liver enzymes, bilirubin and LDH were mildly elevated. Haptoglobin was undetectable and the Coombs test was negative. A blood count performed in 2008 had been unremarkable. The diagnosis of a Coombs negative haemolytic anaemia was made. Despite further investigations, its origin remained unclear: infections, drugs, sickle cells or other haemoglobinopathies, glucose-6-phosphate dehydrogenase or pyruvate kinase deficiency and microangiopathic haemolytic anaemia were ruled out. Because of the abdominal colics, porphyria testing was performed. Increased concentrations of coproporphyrine III, delta-aminolevulinic-acid (urine) and elevated free-and zinc-protoporphyrin (erythrocytes) were observed. These results were not consistent with classical porphyrias because, instead of a single enzyme, a number of enzymes were inhibited. As heavy metals are known to inhibit enzymes such as ALA dehydratase, coproporphyrinogen oxidase and ferrochelatase [1], a blood lead concentration was obtained and found to be 63.2 mg dl -1 (normal < 5 mg dl -1 ). Reasons for lead exposure such as occupation, food, environment or illicit drugs were not detected. Ceramics with lead-containing glazing were not used in the patient's household and none of the family members had elevated blood lead concentrations. On repeated questioning, the patient admitted having taken five ayurvedic pills per day for 2 months until the end of December 2009 to increase his fertility. The pills had been ordered from India and were labelled 'ashwagandha/ mucuna' , which are sold as aphrodisiacs. Left over pills were examined at the Official Food Law Enforcement Authority, where concentrations up to 7.3 mg of lead per pill and traces of arsenic, chromium and mercury were found. Treatment with the oral heavy metal chelator, dimercaptosuccinic acid (DMSA), was started at a dose of 30 mg kg -1 bodyweight per day for 5 days followed by 20 mg kg -1 for 14 days. After 3 weeks, the blood lead concentration had decreased to 17 mg dl -1 ; anaemia and red blood cell morphology had normalized and the patient had become asymptomatic.The majority of cases of adult lead poisoning originate from workplace exposures. Inorganic lead is absorbed from the lungs, especially in adults, or from the gastrointestinal tract, which represents the predominant exposure route in children. Lead from 'herbal medicines' , especially from Asian countries, is an emerging source of heavy metal Figure...

No abstract

Schlüsselwörter Atopische Dermatitis • Digitalisierung • NALA-App • Therapieadhärenz Dieser Artikel soll die Digitalisierung in der Dermatologie näher beleuchten. Dabei werden zunächst der Status Quo beim «Standard of Care» (SOC) sowie bestehende Herausforderungen im Praxisund Patienten-Alltag vorgestellt. Anschließend soll erklärt werden, wie digitale Lösungen dabei helfen können, diese Herausforderungen zu meistern.