16 Sep 2020

September 16, 2020

Written by REBEL Cast, REBEL Core

Take Home Points

  • Wernicke encephalopathy is characterized by ataxia, altered mental status and ophthalmoplegia but patients are unlikely to have all these components
  • Suspect Wernicke encephalopathy in any patient that is at risk of malnutrition or malabsorption and has any one of the classic symptoms
  • Prophylactic administration of thiamine 100 mg IV/IM to at risk patients can prevent development of the disease
  • Once Wernicke encephalopathy has developed, it must be treated with high-dose, IV thiamine
Medical Categories: Toxicology
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28 May 2020

May 28, 2020

Written by REBEL Crit, REBEL EM

Background Information:

Physicians have and continue to heavily contribute to the current opioid epidemic in the United States and Canada.1 Although much of the focus has been opioid prescriptions given to patients in the emergency department,2,3 not much attention has been paid to critically ill patients who survive to hospital discharge. The long-term sequelae of these opioids is concerningly overlooked especially when physicians utilize these medications as part of an “analgesia first” approach to sedating critically ill patients for the purposes of invasive mechanical ventilation (IMV).4 Previous observational studies in Canada found that approximately 85% of critically ill patients receiving IMV were exposed to opioids.1 Furthermore, the average daily opioid dosing for 2-7 days was 63 milligrams of morphine equivalent (MME), increasing to 106 MME per day for patients receiving IMV for greater than 7 days. The authors of this study performed a retrospective chart review of population-based data from Ontario Canada to investigate the frequency of new opioid initiation and persistent opioid use among critically ill patients who received mechanical ventilation. They compared this to patients who were hospitalized but not critically ill.
Medical Categories: Pyschobehavioral, Toxicology
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23 Apr 2020

April 23, 2020

Written by REBEL EM
Background: Electronic cigarette use, or vaping, has been rising in popularity in the United States. Electronic cigarette use has been associated with respiratory symptoms that have collectively been labeled e-cigarette or vaping product use-associated lung injury (EVALI). In a recent study of mass spectrometry of bronchoalveolar lavage samples, Vitamin E acetate was found in 94% of cases in the EVALI group and was not present in the comparison group [2]. Per the CDC data, the number of hospitalized cases peaked in August and September of 2019. Due to identifying the likely etiology of the lung injury, vitamin E acetate, there has been increased regulation and a subsequent decrease in cases; however, vaping-associated lung injury remains in the potential differential diagnosis for patients presenting to the emergency department with unexplained respiratory symptoms.
Medical Categories: Thoracic and Respiratory, Toxicology
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REBEL Review 99: Serotonin Syndrome Tx

Created April 18, 2020 | Toxicology | DOWNLOAD

16 Apr 2020

April 16, 2020

Written by REBEL EM
Background Information: Nausea and vomiting during pregnancy most commonly occurs during the first trimester. If left untreated, the development of hyperemesis gravidarum can lead to further complications characterized by dehydration and electrolyte abnormalities.1 Ondansetron, a 5-HT3 receptor antagonist has quickly become the most frequently prescribed drug in the United States for nausea and vomiting during pregnancy.2 With the creation of an oral dissolving tablet in 2006, Ondansetron’s popularity as an antiemetic continues to rise. In fact, a study from 2014 shows that nearly a quarter of all pregnant women in the United States are using it.3 There is uncertainty in the literature as to the association between Ondansetron and birth defects. While some studies report there is no increased risk in congenital abnormalities among women who took this antiemetic early in pregnancy, other evidence suggests it may be associated with cleft palate and cardiac malformations.2 The authors of this study sought to investigate the association between exposure to Ondansetron during the first trimester of pregnancy and risk of congenital malformations in newborns using a national cohort of publicly insured pregnant women.
Medical Categories: Obstetrics and Gynecology, Toxicology
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