Chūdoku kenkyū : Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology
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The immunoassay screening of benzodiazepines in urine is one of the most important methods of drug analysis in clinical and forensic laboratories. We experienced an unusual case of poisoning wherein the result of Triage DOA immunoassay screening was negative, although Depas (etizolam) was detected in the blood of the victim who had been suspected to prescribe Depas by gas chromatography-mass spectrometry. Depas has been widely used for the treatment of anxiety in Japan. ⋯ The concentrations of M-III and M-V were 700 and 1,600 ng/mL, respectively. AccuSign BZO demonstrated higher specificity-than the other screening kits for the detection of etizolam and its metabolites in urine. Therefore, the types of drugs detected would be increased by combining Triage DOA with AccuSign BZO in ICUs or forensic laboratories.
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Case Reports
[Tricyclic antidepressant overdose rescued by percutanenous cardiopulmonary support: report of two cases].
We report the case of two patients tricyclic antidepressant (TCA) overdoses complicated with severe circulatory failure, successfully resuscitated using percutaneous cardiopulmonary support (PCPS). In case 1, a woman transferred to our emergency department, presented with severe circulatory failure and developed cardiopulmonary arrest. She received prolonged cardiopulmonary resuscitation, and initiated with PCPS. ⋯ The most common cause of death after TCA overdose is cardiovascular toxicities. In current guidelines, cardiopulmonary resuscitation with extracorporeal cardiopulmonary bypass may be particularly effective for these patients to have a reversible etiology without preceding multisystem organ failure. Cardiotoxicities in TCA overdose are reversible and extracorporeal cardiopulmonary support should be promptly considered in refractory arrhythmia and hypotension despite conventional advanced life support.
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The severity of alkaline esophagitis due to sodium hypochlorite ingestion is variable and the findings of endoscope within 48 hours of ingestion are reported to be associated with its prognosis. We report a good recovery case of grade 2B of alkaline esophagitis, which was treated with close observation. The patient was 59-year old man. ⋯ He was extubated and started oral feeding on the 15th day. After that, his hospital course was uneventful and was discharged on the 18th day. 6 months have passed since he left hospital. No esophageal strictures were detected so far.