Acute Tacrolimus Toxicity Successfully Treated with Phenytoin
Tacrolimus is an integral part of immunosuppression following solid organ transplantation. We present a case of acute tacrolimus toxicity in a renal transplant recipient successfully treated with phenytoin.
A 55-year old male with history of end-stage renal disease due to tuberous sclerosis and polycystic kidney disease who had undergone a living related renal transplant 17 years ago was transferred to our facility for evaluation of acute kidney injury (AKI). The patient was admitted to a psychiatric facility for suicidal ideations and had recently been initiated on multiple psychotropic drugs including haloperidol, quetiapine, benztropine, hydroxyzine, citalopram and fluoxetine.
There is an undeniable presence of psychological disorders that have been weaved in to the lyrics of countless songs in the music world. The band Hollywood Undead have composed several songs creating frequent undertones of physiological issues that are diagnosable according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM5). The best representations of Severe Major Depressive Disorder (MDD), substance abuse, suicidal ideation, planning, and attempts that lines up with the DSM 5 I 've come across is represented in their song “Bullet.” The following will be a presentation on severe MDD coupled with substance abuse presenting suicidal
Symptoms/Focus: Dr. Andrew Bourgeois at Simi Valley Emergency Room requested an evaluation of client by the Crisis Team for Suicidal Ideation and Grave Disability. Client placed a call to EMS on his own behalf on the evening of 05/14/2017. Client requested to be picked up from in front of a restaurant and taken to Simi Valley Emergency Room due to suicidal ideation with a plan to "cut head with a saw". Client stated to Dr. Bourgeois that his depression had increased over the last 3 days. Client denied drug or alcohol use, but was positive for amphetamine in the hospital toxicology screen. Client had been seen at Simi Valley ER and
I responded to the address above and contacted Kathleen Berner (DOB 34-51) who was outside the apartment complex with the suspected male who attempted suicide. The male later identified as David Coble (DOB 10-9-58) was sitting upright in a lawn chair near apartment number 1. I asked Coble, David what happened and Coble, David said Coble, David took a handful of Metoprolol. Coble, David said he normally takes the medication for blood pressure. I asked Coble, David if Coble, David took the pills on accident and Coble,
While this writer had some rudimentary knowledge of the impact serotonin had on the brain, "Why? The Neuroscience of Suicide" by Carol Ezzell piqued my curiosity on the role levels of serotonin and the process by which it is absorbed in the brain affect suicidal patients. This article was recently posted on the Neurology and Behavior website as supplemental reading for neurology and behavior's spring semester 2003 class. In this article the writer Carol Ezzell weaves her own personal experience with informative reporting of groundbreaking neuroscience research on suicide. Through further research I discovered various articles on a group of scientists from Columbia University doing research on the difference in people's brains whom have attempted suicide and or succeeded.
Although suicide or attempted suicide is legal in every state, assisting in a suicide is considered illegal in every state except Oregon. Additionally, the Code of Medical Ethics section 2.211 declares that physician assisted suicide is "fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks." There are too many risks associated with physician assisted suicide that managing such a factor would be impossible to control. Even the best medical professionals are human beings with the potential for error. An undiagnosed or untreated mental illness can add to a patients desire to die, which in the case of ph...
Depression and suicide go hand in hand. In fact, 10 to 15 percent of depressed patients commit suicide (Lieber). This is the foundation of the defense argued by Eli Lilly, maker of Fluoxetine, commonly known as Prozac, and other companies manufacturing similar drugs. Although there are some 200 court cases alleging a link between suicide and Prozac this year, Eli Lilly continues to be cleared of all liability (Prozac and Suicide). One such case was brought up in Honolulu, Hawaii. In 1993, William Forsyth Sr., who was 63 and had been on Prozac for only two weeks, killed his wife, June, and himself. The plaintiffs argued that the side effects of Prozac, which included "nervousness, anxiety, insomnia, inner restlessness, manic behavior, self-mutilation and suicidal thoughts," were responsible for the murder-suicide. However, the Lilly spokesman said that those effects were "based on no scientific information at all." He also cited that the...
Waters, Rob. “Antidepressants May Cause Suicide and Violent Behavior in Children and Teenagers.” Treating the Mentally Ill. Ed. Kyla Stinnett, San Diego: Greenhaven Press, 2004. Web. 28 Jan. 2014
This paper introduces a 35-year-old female who is exhibiting signs of sadness, lack of interest in daily activities and suicidal tendencies. She has no interest in hobbies, which have been very important to her in the past. Her lack of ambition and her suicidal tendencies are causing great concern for her family members. She is also exhibiting signs of hypersomnia, which will put her in dangerous situations if left untreated. The family has great concern about her leaving the hospital at this time, fearing that she may be a danger to herself. A treatment plan and ethical considerations will be discussed.
Asberg, M., Träskman, L., & Thoren, P. (1976) took 68 depressed patients with no history of drug abuse, schizophrenia, or brain damage, and examined their cerebral spinal fluid by drawing them out and centrifuging them. They grouped serotonin levels into low and high, and found that more patients in the low group than in the high group have tried to commit suicide, with two patients in that group succeeding. It was noted that the patients who used a more violent method of suicide were in the low group of serotonin levels. This evoked the possibility that low serotonin levels could possibly be a predictor of suicide, however the interactions between these two concepts were unclear. The fact that this was in the cerebral spinal fluid implied that it is not only the brain that plays a part, but also the spinal cord. However, it could also be possible that the brain’s contribution plays a large enough part to be in the cerebral spinal fluid (Asberg, M., Träskman, L., & Thoren, P., 1976). It is also worth noting that serotonin is found to play a part in many other things, such as sleep, pain and aggressive behaviour, which incidentally are all involved in the symptoms of depression, especially the aggression, which links to methods and ways of suicide, and suicide itself as being an aggressive act. This may show that serotonin may not be directly linked to depression or suicide, however most likely it is involved in the process (Asberg, M., Träskman, L., & Thoren, P.,
Early one bright, sunny morning I excitedly arrived to my internship at UnityPoint Health St. Luke’s in Sioux City to discover that a young girl had attempted suicide the night before. After telling her mom she wanted to die during an argument, 17 year old Sally* took a container of Benadryl out of the medicine cabinet, locked the bathroom door, and proceeded to swallow whatever pills where in the bottle. Luckily, she made it to the hospital in time to make a full physical recovery, but it was obvious that there were mental health issues that needed to be addressed. From the original report, it appeared as a simple enough case, a patient attempting suicide in the mental health field is not all that uncommon. However, an interview with the client
Suicidal ideation is common in depression patients, but it often remains undetected (Gensichen, Teising, König, Gerlach, & Petersen, 2010; Keilp, et al., 2012), In addition Wang, et al.( 2009) mentioned that Major depression is a common psychiatric illness and its one of most serious symptoms is suicidal ideation. Moreover, Depression and suicidality have a paradoxical relationship (Keilp, et al., 2012).
Rosen, The Serious Suicide Attempt: Five Year Follow Up Study of 886 Patients, 235 J.A.M.A. 2105, 2105 (1976).
According to the National Institute of Mental Health, scientific evidence has shown that almost all people who take their own lives have a diagnosable mental or substance abuse disorder, and the majority have more than one disorder. In other words, the feelings that often lead to suicide are highly treatable. That’s why it is imperative that we better understand the symptoms of the disorders and the behaviors that often accompany thoughts of suicide. With more knowledge, we can often prevent the devastation of losing a loved one.
Yen, E. F., Hardinger, K., Brennan, D. C., Woodward, R. S., Desai, N. M., Crippin, J. S., . . . Schnitzler, M. A. (2004). Cost-Effectiveness of Extending Medicare Coverage of Immunosuppressive Medications to the Life of a Kidney Transplant. American Journal of Transplantation, 4, 1703-1708. Retrieved May 30, 2014
American Heart Association. (2000). Clinical training in serious mental illness (DHHS Publication No. ADM 90-1679). Washington, DC: U.S. Government Printing Office