Flumazenil, naloxone and the ‘coma cocktail’

Sivilotti, Marco L.A.

doi:10.1111/bcp.12731

Cited by 68 publications

(54 citation statements)

References 63 publications

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“…Consequently, given the abundances of opioid abuse, naloxone administration should strongly be considered, especially in circumstances of unstable vitals even if an opioid toxidrome is not readily apparent 11. While a rapid urine drug screen might be a useful adjunct in determining drug classes of concern, no drug screen is likely to aid in the management of patient stabilisation.…”

Section: Discussionmentioning

confidence: 99%

Novel psychoactive substances: overdose of 3-fluorophenmetrazine (3-FPM) and etizolam in a 33-year-old man

Benesch¹,

Iqbal

2018

BMJ Case Reports

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Though illegal in the UK, in many countries novel psychoactive substances are quasi-legal synthetic compounds that are widely available online under the guise of research chemicals. These substances are relatively cheap and are often undetectable in standard drug screens. Nearly 200 such compounds are introduced yearly, and little is usually known about their metabolism or physiological effects. Consequently, managing patients in overdose situations on largely unknown substances usually involves supportive care, however anticipating and managing atypical side effects are challenging in the absence of knowledge of these compounds. In this report, we discuss our encounter with a 33-year-old unconscious man presenting with coingestion of a novel stimulant 3-fluorophenmetrazine with a rarely used benzodiazepine etizolam. This patient developed seizure-like activity and delayed widespread T-wave inversions, both of which ultimately resolved without sequelae.

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Section: Discussionmentioning

confidence: 99%

Novel psychoactive substances: overdose of 3-fluorophenmetrazine (3-FPM) and etizolam in a 33-year-old man

Benesch¹,

Iqbal

2018

BMJ Case Reports

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“…He was later diagnosed as opioid toxidrome after dramatic response to Naloxone injection, given as per coma cocktail (Hoffman et al, 1992). Bradypnoea, especially central hypoventilation and altered sensorium are appropriate indications for Naloxone use in a case of suspected toxidrome, due to low risk/high benefit ratio (Sivilotti, 2016), however, this coma cocktail has not been universally accepted. We missed initial diagnosis because of very similar features (miosis, bradypnea, coma, diffuse crackles in chest) between two toxidromes (Bey et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Mystifying Toxidrome: A Case of Heroin Body Packer Syndrome

Panda¹,

Kakkanattu²,

Kumar³

et al. 2016

American Journal of Pharmacology and Toxicology

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Drug trafficking is an international problem. Over years it has increased in prevalence and concealment methods. Body packers swallow wrapped packets of illicit drugs, mainly cocaine and heroin and try to conceal them from security personnel. They present to physicians either as body packer syndrome with symptoms of intoxication or asymptomatically on suspicion of drug concealment, for observation. We report a case of middle aged unknown male, found in comatose state on road side by Delhi police (India), brought to our emergency without any signs of injury. Initially organophosphate toxidrome was suspected, later confirmed to be opiod toxidrome with internal concealment of many balloons (of polythene) wrapped packets of heroin. On failure of conservative removal, he underwent laparotomy with complete removal of all the packets. He was discharged in stable condition and handed over to the police. This is the first case report of live heroin body packer syndrome from India.

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“…Es fundamental para su uso tener un claro conocimiento de los antecedentes tóxicos y farmacológicos para excluir el consumo crónico de gabaérgicos, hidrato de cloral, cocaína, antidepresivos y, por tanto, en el contexto de los servicios de urgencias tiene poca utilidad 50 .…”

Section: Acción Directa Acción Indirectaunclassified

Alteración del estado de conciencia en el paciente intoxicado

Mejía

Ramos

Calzada

2017

MedUPB

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Alteración del estado de conciencia en el paciente intoxicadoAlterations in the state of consciousness in intoxicated patients / Alteração do estado de consciência no paciente intoxicado Marie Claire Berrouet Mejía 1 Natalia Eugenia Pino Ramos 2 Marcela Castro Botero 3 Ubier Eduardo Gómez Calzada 4 RESUMEN La disminución del estado de conciencia, específicamente el coma, es un motivo de consulta frecuente en el servicio de urgencias y constituye un reto para el personal de salud por el número de condiciones amenazantes de la vida que se acompañan de este signo clínico. La toxicidad en el sistema nervioso central es una de las manifestaciones más comunes en el paciente intoxicado por cuanto se han encontrado signos y síntomas hasta en un 30%. Este porcentaje es considerable en personas en edad laboral pues la morbilidad derivada de un retraso en la atención y las lesiones secundarias, implican repercusiones sociales. Según su acción en el sistema nervioso central los xenobióticos se dividen en dos grupos: estimulantes que causan agitación, delirium o convulsiones y depresores que provocan grados variables de alteración en el estado de conciencia, desde la somnolencia hasta el coma. El propósito de este artículo es revisar las sustancias depresoras, con enfoque en el coma de origen tóxico. Además de la fisiopatología y los principales tóxicos implicados, se plantea, con base en la evidencia, la mejor aproximación a esta clase de pacientes con el objeto de favorecer el uso razonable de los recursos disponibles y evitar complicaciones y disminuir costos al sistema de salud. Palabras clave: conciencia; sistema nervioso central; coma; toxicidad; envenenamiento agudo; estado mental alterado. ABSTRACTDepression of consciousness -coma, specifically -is a frequent complaint in the emergency room consultation and is a challenge for health personnel, considering the number of life-threatening conditions that may be associated with this clinical sign. Toxicity in the central nervous system is one of the most common manifestations in the poisoned patient, where signs and symptoms have been found in up to 30%. This percentage is significant in working-age individuals as morbidity resulting from a delay in care and secondary lesions involves a social impact. According to their effect on the central nervous system, xenobiotics can be divided into two groups: stimulants that cause states of agitation, delirium or convulsions, and depressants that cause varying degrees of alteration in the state of consciousness, anywhere from drowsiness to coma. The purpose of this article was to review depressants, focusing on coma induced by intoxication. In addition to reviewing the pathophysiology and the main toxic substances involved, we consider the best approach to this class of patients based on the evidence, in order to favor the reasonable use of resources available, while avoiding complications and reducing health system costs.

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Flumazenil, naloxone and the ‘coma cocktail’

Cited by 68 publications

References 63 publications

Novel psychoactive substances: overdose of 3-fluorophenmetrazine (3-FPM) and etizolam in a 33-year-old man

Novel psychoactive substances: overdose of 3-fluorophenmetrazine (3-FPM) and etizolam in a 33-year-old man

Mystifying Toxidrome: A Case of Heroin Body Packer Syndrome

Alteración del estado de conciencia en el paciente intoxicado

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