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In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
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The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
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Tranexamic Acid Neurotoxicity After Nebulization and BAL.

Jeremy Hardin1, Justin Seltzer2, Riku Moriguchi1

  • 1Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, CA; VA San Diego Healthcare System, San Diego, CA; San Diego Division, California Poison Control System, San Diego, CA.

Chest
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PubMed
Summary
This summary is machine-generated.

Pulmonary administration of tranexamic acid can cause serious systemic toxicity, including neurological symptoms and hyperthermia. This highlights the need for careful dosing and monitoring, especially in at-risk patients.

Keywords:
bronchoalveolar lavagetoxicitytranexamic acid

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Area of Science:

  • Pharmacology
  • Pulmonary Medicine
  • Neurology

Background:

  • Tranexamic acid is a widely used hemostatic agent.
  • Systemic toxicity is known but pulmonary administration toxicity is undescribed.
  • Pulmonary arteriovenous malformations (PAVMs) are a relevant clinical context.

Observation:

  • A patient with PAVMs received nebulized and bronchoalveolar lavage (BAL) tranexamic acid.
  • The patient developed altered mental status, myoclonus, and hyperthermia post-procedure.
  • Symptoms were successfully managed with propofol and vecuronium.

Findings:

  • This case describes the first reported instance of systemic toxicity from pulmonary tranexamic acid administration.
  • The toxicity mechanism involves competitive antagonism of GABA-A and glycine receptors.
  • Neurological and systemic hyperthermia symptoms manifested after administration.

Implications:

  • Pulmonary tranexamic acid use necessitates awareness of potential systemic toxicity.
  • Dose reduction and alternative strategies are crucial for patients with PAVMs, renal insufficiency, or advanced age.
  • Further research into safe dosing and monitoring protocols for pulmonary tranexamic acid is warranted.