Methylphenidate acute toxicity

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Oussama Alserwy

A presentation gives a hint on methylphenidate (Ritalin) toxicokinetics, clinical picture and management.

Health & Medicine

Methylphenidate
Acute Toxicity
OUSSAMA ALSERWY

Toxicokinetics
Routes of administration include oral,
inhalational and parenteral.
Metabolism is predominantly by the
liver into the inactive form ritalinic
acid.
Excretion is mainly by the kidney into
urine.

Mydriasis
Irritability, psychosis
Hyperthermia, Seizures
Tachycardia
Hypertension
Arrythmias
Tremors, Hyperreflexia
Abdominal pain,
Vomiting
↓ Sexual Impotence
Clinical Picture
Stimulant

Symptomatic Treatment
• Diazepam
• Phenobarbital
• Phentolamine
• CCBs
• Lidocaine
• Defibrillation

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د/ يحيى الفقي Endocrine emergencies overview المحاضرة التي قدمت يوم الثلاثاء 8 ابريل 2014 في دار الحكمة بالقاهرة من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب و ضمن موديول الطوارئ و التخدير و العناية المركزة

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مشروع إعداد طبيب حكيم ناجح

A major organ of the endocrine system, the anterior pituitary (also called the adenohypophysis or pars anterior), is the glandular, anterior lobe that together with the posterior lobe (posterior pituitary, or the neurohypophysis) makes up the pituitary gland (hypophysis). The anterior pituitary regulates several physiological processes including stress, growth, reproduction and lactation. Proper functioning of the anterior pituitary and of the organs it regulates can often be ascertained via blood tests that measure hormone levels. The anterior pituitary contains five types of endocrine cell, and they are defined by the hormones they secrete: somatotropes (GH); prolactins (PRL); gonadotropes (LH and FSH); corticotropes (ACTH) and thyrotropes (TSH)

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drug induced liver disease DILD is caused by many different drugs of mostly painkillers and fever reducers which contain acetaminophen drug this is hepatotoxic because drugs are absorbed by liver on high dose of this drug lead damage of liver known as liver injury. Rarely absorbed in children. actually people who drink alcohol has high prone to drug injury, but in children in happened because of antiepileptic and antiniotics.the antibiotics most often implicated with liver injury are amoxicillin/clavulanic acid, flucloxacillin and erythromycin .Nonalcoholic Fatty Liver Disease (NAFLD) is the most common forms of chronic liver disease in children and adolescents. It is an inherited disorder that affects the metabolism – the way the body breaks food down into energy.Drug-induced liver injury in children (cDILI) accounts for about 1% of all reported adverse drug reactions throughout all age groups, less than 10% of all clinical DILI cases, and around 20% of all acute liver failure cases in children. The overall DILI susceptibility in children has been assumed to be lower than in adults. Nevertheless, controversial evidence is emerging about children's sensitivity to DILI, with children's relative susceptibility to DILI appearing to be highly drug-specific. The culprit drugs in cDILI are similar but not identical to DILI in adults (aDILI). This is demonstrated by recent findings that a drug frequently associated with aDILI (amoxicillin/clavulanate) was rarely associated with cDILI and that the drug basiliximab caused only cDILI but not aDILI. The fatality in reported cDILI studies ranged from 4% to 31%. According to the US Food and Drug Administration-approved drugs labels, valproic acid, dactinomycin, and ampicillin appear more likely to cause cDILI. In contrast, deferasirox, isoniazid, dantrolene, and levofloxacin appear more likely to cause aDILI. Animal models have been explored to mimic children's increased susceptibility to valproic acid hepatotoxicity or decreased susceptibility to acetaminophen or halothane hepatotoxicity. However, for most drugs, animal models are not readily available, and the underlying mechanisms for the differential reactions to DILI between children and adults remain highly hypothetical. Diagnosis tools for cDILI are not yet available. A critical need exists to fill the knowledge gaps in cDILI. This review article provides an overview of cDILI and specific drugs associated with cDILI. Out of 298 patients enrolled 273 (92%) resolved ⩽1 year from DILI recognition and 25 patients (8%) were chronic. Independent risk factors for chronicity were older age [OR:1.06, p=0.011], dyslipidemia [OR:4.26, p=0.04] and severe DILI [OR:14.22, p=0.005]. Alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TB) median values were higher in the chronic group during follow-up. Values of ALP and TB >1.1 xULN and 2.8 xULN respectively, in the second month from DILI onset, were found to predict chronic DILI (p<0.001)

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