Hypothermia arrhythmia with

Attempts to diminish the overall metabolism of trichloroethylene might be useful (e.g., hypothermia, mixed-function oxidase inhibitors, competitive inhibitors of trichloroethylene metabolism [i.e., P-450 substrates]), if instituted soon enough after trichloroethylene exposure. Catecholamines (especially beta agonists) act in concert with trichloroethylene, increasing the risk of cardiac arrhythmias. Hence, catecholamines should be administered to patients only in the lowest efficacious doses and for certain limited presentations of trichloroethylene poisoning. Ethanol should also be avoided because concurrent exposure to trichloroethylene and ethanol can cause vasodilation and malaise and may potentiate central nervous system depression at high dosage levels of either compound. 

The symptoms of overdose are to some extent predictable from the antimuscarinic and adrenolytic activity of these drugs. Excitement and restlessness, sometimes associated with seizures, and rapidly followed by coma, depressed respiration, hypoxia, hypotension and hypothermia are clear signs of TCA overdose. Tachycardia and arrhythmias lead to diminished cardiac function and thus to reduced cerebral perfusion, which exacerbates the central toxic effects. It is generally accepted that dialysis and forced diuresis are useless in counteracting the toxicity, but activated charcoal may reduce the absorption of any unabsorbed drug. The risk of cardiac arrhythmias may extend for several days after the patient has recovered from a TCA overdose. 

TS is a multisystem disorder, with characteristic functional and developmental abnormalities in several organ systems including heart, skin, eyes, teeth, immune system and the brain consistent with the ubiquitous expression of the Cav1.2 channel. In a study of seventeen children with TS, it was established that while arrhythmias are the most serious element of the disorder, patients have additional elements including congenital heart disease, dysmorphic facial features, developmental and cognitive delays, immune deficiency, intermittent hypoglycemia and hypothermia and four of the seventeen children studied with TS met the criteria... 

Cardiovascular toxicity is also frequently encountered in poisoning. Hypotension may be due to depression of cardiac contractility hypovolemia resulting from vomiting, diarrhea, or fluid sequestration peripheral vascular collapse due to blockade of -adrenoceptor-mediated vascular tone or cardiac arrhythmias. Hypothermia or hyperthermia due to exposure as well as the temperature-dysregulating effects of many drugs can also produce hypotension. Lethal arrhythmias such as ventricular tachycardia and fibrillation can occur with overdoses of many cardioactive drugs such as ephedrine, amphetamines, cocaine, tricyclic antidepressants, digitalis, and theophylline. 

Continuous hemodynamic monitoring is essential during all phases of hypothermia. Cardiac monitoring is necessary because of the increased risk of arrhythmias. Cardiac output is decreased 5% for every 1°C of body temperature reduction. This is thought to be secondary to bradycardia, which has been shown to occur with hypothermia (3). A pulmonary artery catheter may be placed if there is any question of hemodynamic instability. Arterial catheters are used for continuous blood pressure measurement, as well as for access to arterial blood for blood gas and electrolyte analysis. 

Hypothermia is known to cause cardiac dysfunction, particularly arrhythmias (36,37). Careful temperature control and optimal antiar-rhythmic therapy can minimize this problem. However, to avoid severe circulatory dysfunction, knowledge of arrhythmias is required. Hypothermia may be associated with a suppression of the immunological system, which exposes patients to the danger of severe infections. Schwab et al. reported that 7 of 25 stroke patients undergoing hypoth-ermiatherapy suffered a septic syndrome (17). In our hypothermic study, none of the 13 patients who underwent hypothermia therapy for 3-7 d developed severe infectious diseases. However, the remaining patient, who underwent 10 d of hypothermia because of massive cerebral edema, developed septic shock on the 10th day of hypothermia treatment. The immunosuppressive effect appears to be correlated with the depth and... 

The initial clinical review should include a search for known consequences of poisoning, which include impaired consciousness with flacddity (benzodiazepines, alcohol, trichloroethanol) or with hypertonia (tricyclic antidepressants, antimuscaiinic agents), hypotension, shock, cardiac arrhythmia, evidence of convulsions, behavioural disturbances (psychotropic drugs), hypothermia, aspiration pneumonia and cutaneous blisters, burns in the mouth (corrosives). 

The clinical manifestations of overdosage with triflupromazine are characterized by deep, unarousable sleep and possible coma, hypotension and hypertension, extrapyrami-dal symptoms, dystonia, abnormal involuntary muscle movements, agitation, seizures, arrhythmias, ECG changes, hypothermia or hyperthermia, and autonomic nervous system dysfunction. 

Physiologic derangements resulting in hypotension include volume loss because of vomiting, diarrhea, or bleeding apparent volume depletion caused by venodilation arteriolar dilation depression of cardiac contractility arrhythmias that interfere with cardiac output and hypothermia. 

Cardiovascular The study reported the impact of serum potassium changes related to the rate of cardiac arrhythmias and the advantages and disadvantages of potassium supplementation were included. Fifty-four consecutive patients suffering from out-of-hospital cardiac arrest and treated with therapeutic hypothermia for 24 h at a university hospital were included and followed for 48 h. Results observed that serum potassium levels decreased during cooling from a median admission value of 4.0 mmol/L to a nadir of 3.6 mmol/L 6h after target temperature and 76% reached values of 5.5 mmol/L. A total number of 11% of patients experienced ventricular fibrillation or VT [216 j. 

It is known that therapeutic hypothermia (TH) after out-of-hospital cardiac arrest is associated with adverse events such as hypokalaemia and arrhythmias. This study reports the impact of serum potassium changes related to the rate of cardiac arrhythmias and the advantages and disadvantages of potassium (K) supplementation [56 ]. 

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