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Emergency Medicine Clinics of North... Feb 2015Asphyxiants deprive the body of oxygen. Simple asphyxiants displace oxygen from the lungs, whereas systemic asphyxiants interfere with transport of oxygen by hemoglobin... (Review)
Review
Asphyxiants deprive the body of oxygen. Simple asphyxiants displace oxygen from the lungs, whereas systemic asphyxiants interfere with transport of oxygen by hemoglobin or with mitochondrial oxidative phosphorylation. Asphyxiants may be gases, liquids, or solids, or their metabolites. The typical clinical picture of asphyxiant poisoning is one of progressive mental status changes, alteration of breathing, progressively abnormal vital signs, coma, seizures, and eventually cardiovascular collapse and death. Treatment of asphyxiant poisoning is aggressive supportive care, with control of the airway and ventilation and maintenance of cardiac output. Supportive care is often enhanced by the administration of specific antidotes.
Topics: Antidotes; Asphyxia; Diagnosis, Differential; Disease Management; Emergency Medical Services; Humans; Oxygen Inhalation Therapy; Poisoning
PubMed: 25455664
DOI: 10.1016/j.emc.2014.09.014 -
Current Opinion in Clinical Nutrition... Mar 2024Unintentional intoxication comprises a major chunk of all intoxications. Most patients are in the pediatric age group with another set of patients being the elderly.... (Review)
Review
PURPOSE OF REVIEW
Unintentional intoxication comprises a major chunk of all intoxications. Most patients are in the pediatric age group with another set of patients being the elderly. Substances found to cause accidental intoxication vary from country to country and even within different regions of a country. Frequent reviews of current literature are needed to be abreast of trends.
RECENT FINDINGS
Prescription drugs and household chemicals are major culprits when it comes to accidental intoxication. Acetaminophen, digoxin and metformin are some of the prominent prescription drugs frequently associated with unintentional intoxications. Increasingly alcohol based hand sanitizers are becoming an important etiology of these events, following their increased usage during the COVID-19 pandemic. Pattern recognition to identify class of intoxicant and supportive care including prevention of further absorption and increased excretion are cornerstones of therapy. Antidote when available should be used promptly.
SUMMARY
Knowledge about current epidemiology of accidental intoxications, toxidrome pattern recognition and appropriate antidote usage beside adequate and timely supportive care help in successful management of the unfortunate victim of accidental intoxication.
Topics: Humans; Child; Aged; Antidotes; Pandemics; Ethanol; Metformin
PubMed: 38260945
DOI: 10.1097/MCO.0000000000001013 -
Tijdschrift Voor Psychiatrie 2021The prevalence of psychopathology did not decrease in prosperous countries, despite evidence-based treatment, focus on prevention and long prosperity. (Review)
Review
BACKGROUND
The prevalence of psychopathology did not decrease in prosperous countries, despite evidence-based treatment, focus on prevention and long prosperity.
AIM
To investigate if the eastern concept of self-compassion can help to decrease the prevalence of psychopathology.
METHOD
Literature review and interviews with experts.
RESULTS
Health is defined as a state of complete wellbeing. This seems like a maintainable goal in prosperous countries. Setbacks are, however, an unavoidable part of life and therefore resilience is important. Normalizing a state of complete wellbeing comes at the expense of resilience because it increases stress after setbacks. Stress is an important precursor to psychopathology because it leads to suffering and dysfunction. The concept of self-compassion and compassion in a broader sense, refer to the capacity to be mild when setbacks occur. (Self)-compassion helps to regulate stress and can therefore improve resilience and contribute to decrease the prevalence of psychopathology.
CONCLUSION
In prosperous countries, there is little attention to resilience. The concept of (self)-compassion can contribute to mental resilience and can help to decrease the prevalence of psychopathology. Therefore, it deserves a place in the diagnostics and treatment of psychiatric disorders.
Topics: Antidotes; Anxiety; Empathy; Humans; Mental Disorders; Psychopathology; Resilience, Psychological; Self Concept
PubMed: 33913145
DOI: No ID Found -
Toxicology and Applied Pharmacology May 2023Sodium nitrite (NaNO) is a universal antidote for patients with cyanide poisoning. However, its use has serious drawbacks in terms of efficacy and safety. Herein, we...
Sodium nitrite (NaNO) is a universal antidote for patients with cyanide poisoning. However, its use has serious drawbacks in terms of efficacy and safety. Herein, we present a promising antidote: methemoglobin (metHb)-albumin clusters. The metHb-albumin cluster is made by a metHb core wrapped by covalently bound human serum albumin. Spectral analyses proved that the metHb-albumin clusters possessed cyanide-binding properties similar to those of naked metHb. In vitro cell experiments showed that metHb-albumin clusters prevented the cyanide-induced inhibition of cytochrome c oxidase activity, resulting in a strong cytoprotective effect. In mice subjected to cyanide poisoning, metHb-albumin clusters reduced mortality and alleviated metabolic acidosis, while maintaining the activity of cytochrome c oxidase in organs; their efficacy was better than that of NaNO. Furthermore, the oxygen carrying capacity was maintained in poisoned mice treated with metHb-albumin clusters and was low in those treated with NaNO. These results indicate that metHb-albumin clusters could be a more effective and safer antidote against cyanide poisoning than NaNO.
Topics: Humans; Mice; Animals; Methemoglobin; Cyanides; Antidotes; Electron Transport Complex IV; Albumins
PubMed: 36934860
DOI: 10.1016/j.taap.2023.116472 -
Trends in Pharmacological Sciences Jul 2022High lethality, fast action, and simple synthesis make nerve agents (NAs) the most dreaded chemical weapons (CWs) of mass destruction in the world. Disturbances of the... (Review)
Review
High lethality, fast action, and simple synthesis make nerve agents (NAs) the most dreaded chemical weapons (CWs) of mass destruction in the world. Disturbances of the autonomic nervous system and neuromuscular junction (NMJ) by NAs and organophosphorus (OP) insecticides lead to cholinergic crisis and skeletal muscle paralysis. Current medical intervention has remained mostly unchanged since their first discovery in the 1950s. Within this overview, we have followed their development, clinical successes, and failures and discuss the major demerits of available antidotes. In current times, with precision medicine becoming increasingly relevant in various fields of medicine, the antidotal approach should be broadened to better cope with individual cases of NA intoxication. When possible, countermeasures could be targeted directly to achieve a better patient prognosis. As the threat of NA misuse and accidental cases of OP insecticide intoxication are still omnipresent, advancement of intervention expertise and further research in this field should be supported.
Topics: Antidotes; Cholinesterase Reactivators; Humans; Organophosphate Poisoning; Oximes
PubMed: 35643835
DOI: 10.1016/j.tips.2022.04.008 -
Advances in Experimental Medicine and... 2017Diseases can be caused naturally by biological agents such as bacteria, viruses and toxins (natural risk). However, such biological agents can be intentionally... (Review)
Review
Diseases can be caused naturally by biological agents such as bacteria, viruses and toxins (natural risk). However, such biological agents can be intentionally disseminated in the environment by a State (military context) or terrorists to cause diseases in a population or livestock, to destabilize a nation by creating a climate of terror, destabilizing the economy and undermining institutions. Biological agents can be classified according to the severity of illness they cause, its mortality and how easily the agent can be spread. The Centers for Diseases Control and Prevention (CDC) classify biological agents in three categories (A, B and C); Category A consists of the six pathogens most suitable for use as bioweapons (Bacillus anthracis, Yersinia pestis, Francisella tularensis, botulinum neurotoxins, smallpox and viral hemorrhagic fevers). Antibodies represent a perfect biomedical countermeasure as they present both prophylactic and therapeutic properties, act fast and are highly specific to the target. This review focuses on the main biological agents that could be used as bioweapons, the history of biowarfare and antibodies that have been developed to neutralize these agents.
Topics: Animals; Antibodies; Antidotes; Biological Warfare; Bioterrorism; Disaster Planning; Host-Pathogen Interactions; Humans
PubMed: 29549640
DOI: 10.1007/978-3-319-72077-7_9 -
Emergency Medicine Clinics of North... May 2022Management of the acutely poisoned patient requires supportive care and timely administration of antidotes to minimize ongoing toxicity and mortality. New applications... (Review)
Review
Management of the acutely poisoned patient requires supportive care and timely administration of antidotes to minimize ongoing toxicity and mortality. New applications for old antidotes include utilization of methylene blue and hydroxocobalamin in vasoplegia. Fomepizole is also being evaluated as a potential adjunct in acetaminophen toxicity. Other advancements include individualized acetylcysteine dosing regimens for acetaminophen toxicity and carnitine supplementation in valproic acid toxicity. Additional antidote considerations include administration of lipid emulsion in lipophilic xenobiotic exposure not responsive to standard resuscitative modalities. These expert recommendations provide guidance for providers caring for the acutely poisoned patient.
Topics: Acetaminophen; Acetylcysteine; Antidotes; Fomepizole; Humans; Methylene Blue
PubMed: 35461629
DOI: 10.1016/j.emc.2022.01.008 -
Theranostics 2021Poisons always have fascinated humankind. Initially considered as deleterious or hazardous substances, the modern era has witnessed the controlled utilization of... (Review)
Review
Poisons always have fascinated humankind. Initially considered as deleterious or hazardous substances, the modern era has witnessed the controlled utilization of dangerous poisons in medicine and cosmetics. Simultaneously, antidotes have become crucial as reversal agents to counteract the effects of a poison, and they are also used today to positively cancel the benefits of a poison after use. Currently, the majority of poisons are composed of small molecules. This review focuses on recent developments to reverse or prevent toxic effects of poisons by encapsulation in host molecules. Cyclodextrins, cucurbiturils, acyclic cucurbituril derivatives, calixarenes, and pillararenes, have been reported to largely impact the effects of toxic compounds, thus extending the current paradigm of small molecule antidotes by adding a new family of macrocyclic compounds to the current arsenal of antidotes. Along this line of research, endogenous "harmful" species are also sequestered by one or more of these supramolecular host molecules, expanding the potential of supramolecular antidotes to diverse therapeutic areas.
Topics: Animals; Antidotes; Humans; Macrocyclic Compounds; Poisons; Small Molecule Libraries
PubMed: 33391548
DOI: 10.7150/thno.53459 -
Mini Reviews in Medicinal Chemistry 2019Methanol is the simplest alcohol. Compared to ethanol that is fully detoxified by metabolism. Methanol gets activated in toxic products by the enzymes, alcohol... (Review)
Review
Methanol is the simplest alcohol. Compared to ethanol that is fully detoxified by metabolism. Methanol gets activated in toxic products by the enzymes, alcohol dehydrogenase and aldehyde dehydrogenase. Paradoxically, the same enzymes convert ethanol to harmless acetic acid. This review is focused on a discussion and overview of the literature devoted to methanol toxicology and antidotal therapy. Regarding the antidotal therapy, three main approaches are presented in the text: 1) ethanol as a competitive inhibitor in alcohol dehydrogenase; 2) use of drugs like fomepizole inhibiting alcohol dehydrogenase; 3) tetrahydrofolic acid and its analogues reacting with the formate as a final product of methanol metabolism. All the types of antidotal therapies are described and how they protect from toxic sequelae of methanol is explained.
Topics: Alcohol Dehydrogenase; Antidotes; Enzyme Inhibitors; Humans; Methanol; Molecular Structure
PubMed: 30864518
DOI: 10.2174/1389557519666190312150407 -
Current Cardiology Reports May 2023Our objective is to describe currently available reversal agents for direct oral anticoagulants (DOACs), their target population, the available clinical practice... (Review)
Review
PURPOSE OF REVIEW
Our objective is to describe currently available reversal agents for direct oral anticoagulants (DOACs), their target population, the available clinical practice recommendations and future directions.
RECENT FINDINGS
Specific (idarucizumab for dabigatran and andexanet alfa for direct factor Xa inhibitors) and non-specific (prothrombin complex concentrates) reversal agents are effective in neutralizing the anticoagulant effect of DOACs. New investigational antidotes such as ciraparantag and VMX-C001 offer an alternative to andexanet alfa in reversing the anticoagulant activity of direct oral factor Xa inhibitors, but more clinical data are needed before they could be licensed for use. Specific reversal agents are recommended for use in clinical situations within their licensed indications (i.e.: reversal of DOACs in patients with severe uncontrolled or life-threatening bleeding or in need of emergency surgery or other invasive procedures), while non-specific reversal agents may be used when specific antidotes are not available or indicated.
Topics: Humans; Anticoagulants; Antidotes; Dabigatran; Hemorrhage; Factor Xa Inhibitors; Administration, Oral; Recombinant Proteins
PubMed: 36976497
DOI: 10.1007/s11886-023-01858-x