Treatment of Caffeine Intoxication by Exchange Transfusion in a Newborn

Perrin, C; Debruyne, Danièle; Lacotte, J; Laloum, D; Bonte, Jacques; Moulin, Maryline

doi:10.1111/j.1651-2227.1987.tb10546.x

Cited by 23 publications

(9 citation statements)

References 11 publications

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“…Due to the lack of appropriate quality control, these preparations often provided variable amounts of caffeine from one preparation to other and were a cause of some adverse events. [91,94] The study design for selected trials with caffeine citrate and major outcome measures used to evaluate its efficacy are described in table I. There is only one randomized, placebo-controlled, double-blind study of caffeine in premature infants.…”

Section: Clinical Trials With Caffeinementioning

confidence: 99%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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In the last decade, knowledge regarding the neurodevelopment and functional aspects of the respiratory centers during postnatal maturation has increased substantially. However, an increase in such knowledge has not provided a basis for change in practice. The diagnosis of apnea of prematurity (AOP) is one of exclusion. All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. The primary goal of any treatment of AOP is to prevent the frequency of apnea lasting >20 seconds, and/or those that are shorter, but associated with cyanosis and bradycardia. The clinical management of AOP is not much different today than it was two decades ago, with pharmacologic and nonpharmacologic treatment options remaining the mainstay of therapy. Methylxanthines are still the most widely used pharmacologic agents. Due to the wider therapeutic index of caffeine and ease of once daily administration, it should be the preferred agent. Doxapram, or nonpharmacologic treatment measures such as nasal continuous positive airway pressure, may be considered in infants who are unresponsive to methylxanthine treatment alone. Treatment should be continued until there is complete resolution of apnea, and for some time thereafter. The choice of method for weaning treatment remains one of individual physician preference. Discharge from hospital after apnea requires close monitoring and some infants will require home apnea monitors. The decision to provide a home apnea monitor should be individualized for each patient, depending on the effectiveness of treatment and clinical response.

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Section: Clinical Trials With Caffeinementioning

confidence: 99%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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“…Infants with severe toxicity who are unable to tolerate HD may respond to exchange transfusion and MDAC. 83,86,87 General management includes meticulous attention to airway, breathing, and circulation. The patient should be placed on a continuous cardiac monitor, and an ECG should be obtained as soon as possible.…”

Section: Cardiotoxicodynamicsmentioning

confidence: 99%

Cardiotoxicodynamics

Menke

Walsh

King

2015

Emergency Medicine Clinics of North America

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“…TREX has been used in toxicology for poisoning from aniline, arsine, chloramines, salicylates (infants), theophylline (neonates), sodium chlorate, carbon monoxide, cyanide and, methemoglobinemia [57,[63][64][65][66][67][68][69][70]. TREX is performed either manually or is automated with the addition of replacement fluids that include crystalloids, albumin and/or plasma.…”

Section: What Therapeutic Modalities Exist To Treat Acute H 2 S Exposmentioning

confidence: 99%

Case files of the university of cincinnati fellowship in medical toxicology: Two patients with acute lethal occupational exposure to hydrogen sulfide

Policastro

Otten

2007

J. Med. Toxicol.

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We are presenting cases of 2 employees of a chemical plastics manufacturing plant who experienced acute, brief, inhalational exposure to lethal concentrations of hydrogen sulfide in a confined space. Eight other coworkers not present in the immediate exposure area also presented to local health care facilities with mild complaints of headache, nausea, and dizziness, but they suffered no significant sequelae.Patient #1 was a 55-year-old man who, while working in a confined space, uncoupled a nozzle from a steam pipe, collapsed within one minute, and suffered cardiopulmonary arrest. He had a prior history of asthma, hyperlipidemia, coronary artery disease, and was taking lisinopril, aspirin, and lipitor. Following chest compressions and rescue breathing, both by on-scene responders and EMS, the patient's blood pressure was 210/110 mmHg, the pulse was 100 bpm, and ventilation was assisted at 14/minute. On examination, the patient was minimally combative, with a Glasgow coma score of 6 (E1, V1, M4), with pupils 3 mm bilaterally and reactive to light. The patient had a small partial-thickness burn to the right chest, presumed to be a thermal burn from steam or the hot pipe. No cyanosis or pulmonary crackles were noted. Because of respiratory distress, the patient was intubated on-scene using fentanyl, diazepam, and vecuronium by the combined nurse-physician Air EMS flight team. Post-intubation vital signs were as follows: blood pressure 130/69 mmHg, pulse 95 bpm, respirations 14/min (assisted), and oxygen saturation 98% on 100% FiO 2 . The patient's temperature on arrival to the Emergency Department (ED) was 98.2°F (36.8°C), where his examination remained unchanged.Diagnostic studies were obtained in the ED. Arterial blood gas analysis on 100% O 2 showed: pH 7.24, pCO 2 58 mmHg, pO 2 284 mmHg, oxyhemoglobin 97.2%, deoxyhemoglobin 2.0%, methemoglobin 0.3%, and carboxyhemoglobin 0.0%. The blood appeared red. An electrocardiogram revealed a narrow complex tachycardia, without Q waves, ST-segment abnormalities, or interval changes. Serum chemistries were as follows: a sodium of 139 mEq/L, potassium of 4.2 mEq/L, chloride of 105 mEq/L, bicarbonate of 25 mEq/L, BUN of 15 mg/dL, creatinine of 0.9 mg/dL, and glucose of 156 mg/dL. Creatinine kinase (CK) was 299 IU/L, CK-MB 2.2 IU/L, and troponin-I was 0.05 IU/L. A complete blood count showed: white blood cells at 9.0 k/mm 3 , hemoglobin at 13.0 g/dL, hematocrit at 38.2%, and platelets at 130/mm 3 . Coagulation studies were normal, and a chest radiograph showed adequate endotracheal tube placement, absence of pulmonary edema, and a widened mediastinal silhouette, likely due to projection artifact on an antero-posterior film.Patient #2 was a 53-year-old male co-worker, with a history of hypertension, but he was not receiving medical therapy. He was

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Treatment of Caffeine Intoxication by Exchange Transfusion in a Newborn

Cited by 23 publications

References 11 publications

Treatment of Apnea of Prematurity

Treatment of Apnea of Prematurity

Cardiotoxicodynamics

Case files of the university of cincinnati fellowship in medical toxicology: Two patients with acute lethal occupational exposure to hydrogen sulfide

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