Related Experiment Video
Updated: Jun 10, 2025
04:50
Direct Tracheal Instillation of Solutes into Mouse Lung
Published on: August 29, 2010
29.1K
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
|October 10, 2024
Summary
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.
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.
Related Concept Videos
01:26Endoscopic Studies II: Thoracocentesis
208
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
208
01:14Prevention of Further Absorption of Poison
791
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...
791
01:12Local Anesthetics: Adverse Effects
394
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.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
394
01:29Acute Respiratory Failure-V
124
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.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
124
01:26Toxic Reactions: Overview
954
When toxic substances penetrate the human body, they disseminate to various tissues, undergoing metabolic changes. This process yields reactive metabolites that may covalently bind with specific target molecules, resulting in toxicity.
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...
954
01:17Endotracheal Intubation II: Nursing Management
515
Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
515