CJEM Articles: adverse effects

Displaying 1-3 of 3 results

  • Do fluoroquinolones commonly cause arthropathy in children?
    November 2007 9 6
    Clinton T. Forsythe, Michael E. Ernst

    Objective: The objective of this paper was to review the relation between fluoroquinolone (FQ) use and arthropathy in children.

    Methods: The biomedical literature from January 1980 to February 2007 was searched using PubMed. Key search terms included fluoroquinolones, arthropathy, tendinopathy and children. Literature was included if it was a clinical trial or meta-analysis examining the use of 1 or more FQs in a pediatric human population and if it had a primary outcome measure of reported incidence of arthropathy or tendinopathy. Articles were excluded if the primary outcome measure was efficacy of an FQ in a particular pediatric disease state, and evaluated safety was a secondary end point.

    Results: Data was reviewed from 4 large retrospective studies. Three of the 4 studies failed to find a significant link between musculoskeletal injury and FQ treatment. One study reported a correlation between use of pefloxacin and arthropathy, but the authors' conclusions supported the use of FQs in select pediatric cases.

    Conclusion: Arthropathy that occurs as a result of FQ use in children has not been adequately supported by published data from safety trials in human children. Concerns about arthropathy with FQs should not preclude their use by emergency physicians when appropriate and necessary in pediatric patients.

  • Bicarbonate therapy for unstable propafenone-induced wide complex tachycardia
    September 2004 6 5
    Jeff Brubacher

    A previously healthy 73-year-old woman presented to hospital with acute atrial fibrillation. After intravenous procainamide failed to restore sinus rhythm, she was treated with 300 mg of oral propafenone and discharged with a prescription for propafenone and propranolol. Six hours later she took 150 mg of propafenone as prescribed. Within 1 hour she became dyspneic and collapsed. On arrival in hospital she was unconscious, with a wide complex tachycardia and no obtainable blood pressure. After defibrillation and lidocaine, she converted to a wide complex sinus rhythm, but remained profoundly hypotensive despite intravenous epinephrine and dopamine. Hypertonic sodium bicarbonate (HCO3) was administered and, shortly thereafter, her blood pressure increased, her QRS duration normalized and her clinical status improved dramatically. In this case of severe refractory propafenone-related cardiac toxicity, intravenous HCO3 led to a profound clinical improvement. Emergency physicians should be familiar with the syndrome of sodium-channel blocker poisoning and recognize the potentially important role of bicarbonate in its treatment.

  • Fomepizole in the treatment of ethylene glycol poisoning
    May 2002 4 3
    Tammy L. Hall

    The management of ethylene glycol poisoning is reviewed, with a focus on the use of the new antidote fomepizole. Ethylene glycol is a widely used industrial agent that is also easily obtained commercially, usually as radiator antifreeze. Ingestion of as little as 30 to 60 mL can result in death or serious permanent disability. Traditional management of poisoning includes the use of ethanol, with or without hemodialysis. Activated charcoal is not indicated, and gastric lavage may be beneficial only in the first hour after ingestion. Cofactors such as pyridoxine and thiamine may be beneficial in patients deficient in these vitamins. A new antidote, fomepizole, has recently been approved for use in Canada. Like ethanol, it is a competitive inhibitor of alcohol dehydrogenase. Potential benefits of fomepizole include its ease of administration and lack of serious adverse effects. Fomepizole may be recommended over ethanol in situations in which avoidance of ethanol-induced side effects is imperative or when ethanol is not readily available. Further studies are required to verify its comparative efficacy and cost-effectiveness compared to ethanol.