One-fifth of the ingestions resulting in an emergency department visit were for supplement-related adverse events involving unsupervised ingestions in children.
The mean age of patients treated in the emergency department was 32 years, with patients over the age of 65 years more likely to be hospitalized. They were able to project that an average of 23,005 emergency department visits for adverse events due to dietary supplements occur annually, with 2,154 patients being admitted to the hospital. The researchers evaluated their data a variety of ways and uncovered a number of interesting observations. Additional products that are often utilized by consumers for complementary health but do not fall under the regulatory definition of dietary supplement (eg, topically administered herbal or homeopathic products) were also included in the analysis. This analysis included herbal or complementary nutritional products (including botanicals, microbial additives, and amino acids) and micronutrients (vitamins and minerals) but excluded products that are typically considered to be foods or drinks (eg, energy drinks, herbal tea beverages). Data concerning adverse events due to dietary supplements were obtained from the years 2004 through 2013. 2015 35(4):483-484.ĪDVERSE EVENTS TO DIETARY SUPPLEMENTS CAUSING EMERGENCY DEPARTMENT VISITSĪ nationally representative surveillance study was conducted utilizing the National Electronic Injury Surveillance System (NEISS) with data from 63 representative emergency departments. The authors hypothesized that the patient's anisocoria may have been due to anticholinergic features of escitalopram. The authors cite that anisocoria and mydriasis have occurred with fluvoxamine, bupropion, paroxetine, and sertraline. Severe illnesses and various anticholinergic and sympathomimetic drugs may also cause anisocoria and mydriasis. Anisocoria can occur in patients with intracranial aneurysm, ischemia, high intracranial pressure, brain tumors, and head trauma, which can all paralyze the oculomotor nerve. The authors emphasize that even though anisocoria is not a life-threatening condition, it is a symptom of a number of life-threatening conditions. After 7 months of follow-up, the patient tolerated venlafaxine well and anisocoria did not recur. At this time, escitalopram was discontinued and venlafaxine was started at 37.5 mg daily and titrated up to 150 mg daily. The patient asked to be reinitiated on escitalopram 5 mg daily for her anxiety, but after 6 days of treatment her anisocoria again developed. The patient was then referred for neurology and neurosurgery consultations however there were no abnormal neurologic findings.Įscitalopram was discontinued after 4 days, the patient's pupils returned to normal size. The patient did not have a history of anisocoria. The ophthalmologist reported that the patient's ocular examination was normal except for the anisocoria. The patient's pupillary responses were equal with light exposure.
Her eye examination revealed a right pupil diameter of 9 mm and a left pupil diameter of 5 mm with room light. On the seventh day of escitalopram therapy, anisocoria was observed and the patient was seen by an ophthalmologist.Īnisocoria is a condition in which the patient exhibits unequal pupil size under the same light conditions.
The patient was diagnosed with generalized anxiety disorder and started on escitalopram ( Lexapro) 5 mg daily for 3 days and titrated up to 10 mg daily for 4 days. Laboratory tests and her physical examination were unremarkable. Her psychiatric, memory, and intelligence assessments were normal, however her affect and mood were anxious. Her symptoms, along with anxiety while studying, were unwillingness, fatigue, and insomnia lasting for 6 months. An 18-year-old female student complained of anxiety while studying for her college entrance examination.
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