1/4. subarachnoid hemorrhage and death following coingestion of MDMA with other drugs.Ecstasy, the popular name for 3,4-methylenedioxymethamphetamine (MDMA), is a synthetic amphetamine derivative. It stimulates the sympathetic nervous system, producing serious adverse effects on the cardiovascular system. We present a 20-year-old female patient, who developed subarachnoid hemorrhage (SAH) and death following MDMA and coingestion with other drugs. She suffered from severe headache followed by vomiting, and conscious change 5 hours after an intake of 1 tablet MDMA and other drugs at a dance club. Her blood pressure was 226/164 mmHg, pulse rate 164/min, respiratory rate 30/min on arrival at our emergency department. Diffuse rales were heard over both lung fields. Both pupils' sizes were 4 mm, with sluggish reaction to light. A 12 lead electrocardiograph showed sinus tachycardia, ST depression in the inferior leads and V4 to V6 precordial leads. Laboratory findings revealed normal except a slightly raised white cell count and glucose. Arterial blood gas analysis showed pH was 7.333, with PaCO2 24.6 mmHg, PaO2 151.7 mmHg and HCO3 12.8 mmol/L. Chest x-ray revealed acute pulmonary edema. Urgent computerized tomography scanning of the head demonstrated SAH. Her condition continued to deteriorate, and went to deep coma and shock status. She expired on the second day although we treated aggressively.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/4. Fatal metabolic acidosis, hyperglycemia, and coma after steroid therapy for kearns-sayre syndrome.Two adolescent boys with kearns-sayre syndrome (progressive external ophthalmoplegia, heart block, elevated CSF protein, and ragged-red muscle fibers) developed lethargy, increasing somnolence, polydipsia, polyphagia, and polyuria after a brief course of steroid therapy. Both had hyperglycemia and acidosis. Nonketotic, lactic acidosis was present in one and ketosis in the other. Severe respiratory failure developed, and both patients died. Postmortem revealed fatty infiltration of the pancreas in addition to a diffuse spongiform encephalopathy.- - - - - - - - - - ranking = 4keywords = coma (Clic here for more details about this article) |
3/4. Near-death experiences in a pediatric population. A preliminary report.Numerous accounts of a unique psychological state associated with near-fatal events have been described in adults; however, we know of no studies in the medical literature of the nature or incidence of such experiences in children. Four of seven children who survived cardiopulmonary arrests or coma associated with trauma, drownings, or hyperosmolar states reported near-death experiences. Their subjective accounts of their experiences included a sense of being out of the body, traveling in a tunnel or staircase, seeing beings dressed in white, and a decisional return to the body. Six patients hospitalized in the intensive care unit for epiglottitis, heart surgery, or guillain-barre syndrome, all of whom had mechanical ventilatory support and were treated with anesthetic agents and narcotics, had no memories of the time they were unconscious. Clearly, children report near-death experiences similar to ones previously described in adults. Further systematic study of this phenomenon is indicated.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/4. A near-death experience in a 7-year-old child.Near-death experiences occurring to persons who have survived near-terminal events, such as cardiac arrests or profound comas, have been widely reported in the lay literature; however, there is little documentation of such events in the medical literature. These experiences generally have a consistent core of euphoric affect, an out-of-the-body state, encountering a being of light, meeting others (especially dead relatives), and going from a dark tunnel to a world of light. This core remains consistently present despite wide variations in the religious or cultural background of the person. Such an event occurred to a 7-year-old near-drowning victim. Pediatricians should be alerted to the potential need for counseling in children who have survived near-fatal events.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |