Septic encephalopathy: evidence for altered phenylalanine metabolism and comparison with hepatic encephalopathy

Article Abstract:

Septic encephalopathy (SE) is a syndrome characterized by periods of confusion, stupor, or coma resulting from sepsis, or the infection of the blood with microorganisms. The disease process in SE resembles that in hepatic encephalopathy (HE), a brain disease caused by impaired liver function. The resulting changes in blood levels of amino acids (substances that make up proteins) may adversely affect the production of neurotransmitters, substances that transmit nerve impulses, and thereby contribute to the development of encephalopathy. The role of metabolic abnormalities in the disease processes of SE and HE was assessed by measuring levels of phenylethylamine (PEA), phenylacetic acid (PAA), and ammonia, which are products of amino acid metabolism. These substances were measured in the blood and cerebrospinal fluid (CSF) which surround the brain and spinal cord in 11 patients with septic encephalopathy, nine patients with hepatic encephalopathy, and nine normal subjects. Blood and CSF levels of PAA were increased in patients with both types of encephalopathy, but PEA levels were not elevated. The CSF amino acid levels were increased in patients with HE, but only the amino acid phenylalanine was increased in patients with SE. The transport of amino acids into the brain from the blood, and blood ammonia levels were increased in patients with HE, but not in patients with SE. The results show that products of phenylethylamine contribute to SE and HE, although these two disease processes differ in many aspects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Brain diseases, Amino acid metabolism, Septicemia

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Intravenous methylphenidate abuse: prototype for prescription drug abuse

Article Abstract:

Methylphenidate hydrochloride (Ritalin-SR) is a medication commonly prescribed for hyperactive children. The drug is a stimulant, not unlike cocaine or amphetamines in some of its effects. As methylphenidate has been prescribed more frequently of late for hyperactive children and those with attention-deficit disorder, more cases of its abuse have been recognized. A series of 22 patients who were known methylphenidate abusers were described. Nine of these had children who were on methylphenidate for hyperactivity. All of these patients had long histories of drug abuse; 21 of them used the methylphenidate intravenously. All had complications attributable to their use of the drug. Among these were weight loss, anemia, skin infections, lung disease, psychiatric and neurologic symptoms, including hallucinations, paranoia, and seizures. Methylphenidate is prescribed as pills, but it does dissolve in water, lending itself to intravenous abuse. However, some components of the Ritalin-SR preparation do not dissolve in water, and these solid particles are thought to cause the various types of lung disease seen. Of note is the fact that the methylphenidate abused by these patients was obtained solely through physicians' prescriptions. Since this is a controlled substance, educating physicians to recognize drug-seeking behavior and requiring such devices as triplicate prescription forms with meticulous record-keeping are among the mechanisms necessary to reduce the abuse of methylphenidate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Dosage and administration, Methylphenidate, Medication abuse, Prescription drug abuse, Methylphenidate hydrochloride, Ritalin-SR (Medication)

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Fulminant hepatic failure associated with intravenous erythromycin lactobionate

Article Abstract:

Erythromycin, a broad spectrum antibiotic, is commonly used to treat patients allergic to penicillin. Intravenous administration is used to treat lung infections such as Legionnaires's disease. Any effects the drug has on the liver are usually reversible and resolve once the medication is discontinued. This is the first report of intravenous erythromycin inducing liver failure and death. A 72-year-old man with a history of lung cancer was admitted to the hospital because blood-streaked sputum during coughing and a mild fever. Chest X-ray revealed a lung infection, and intravenous erythromycin was initiated. A week later there was evidence of liver malfunctioning and red blood cell destruction. Although the drug was discontinued and supportive therapy was instituted, the patient became increasingly disoriented, lapsed into a coma and died three days later. Liver toxicity of erythromycin lactobionate after intravenous administration has not been well studied, although some cases have been reported after oral administration. It is suggested that patients receiving intravenous erythromycin be monitored with periodic blood tests to measure liver enzymes, an indicator of liver functioning. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Development and progression, Drug therapy, Liver, Erythromycin, Respiratory tract infections

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