J Emerg Med
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The role of thrombolytic treatment in patients with intermediate high-risk pulmonary embolism (IHR-PE) remains controversial. ⋯ Thrombolysis was associated with a significant reduction of the combined endpoint of hemodynamic decompensation and death during hospitalization and lower all-cause mortality after 1 year in an unselected group of patients with IHR-PE. Further studies are required to improve the therapy of IHR-PE and to identify the subgroup of patients that might benefit from thrombolytic therapy.
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Otilonium bromide is a quaternary ammonium compound commonly used in the management of irritable bowel syndrome. There are no previously published cases of overdose of otilonium bromide in humans. Due to its poor systemic absorption, it acts locally and has an excellent safety profile. Data from safety and postmarketing observation showed that otilonium bromide is well tolerated and that side effects do not differ significantly from those seen with placebo. The drug has proven to be practically toxicity free in animals and hence, assumed not to cause any specific problems in humans in case of overdose. ⋯ We report a rare case of a 16-year-old girl who developed systemic hypotension (76/40 mm Hg) after an overdose of otilonium bromide tablets. She ingested 25 tablets of otilonium bromide (40 mg) over a period of 4 h. Subsequently, she responded to a bolus of normal saline and calcium gluconate, leading to normalization of her hemodynamic parameters. Why Should an Emergency Physician Be Aware of This? Due to a lack of reported cases, it is generally assumed that otilonium bromide overdose does not cause any specific problems in humans. However, with the drug being widely used for irritable bowel syndrome and other conditions, the chance of encountering cases of otilonium bromide overdose will increase. Through this case we aim to increase awareness among emergency physicians regarding the potential toxic effects of otilonium bromide overdosage.