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Ergotism

Ergotism is a condition with symptoms of convulsion and gangrene due to ergot poisoning. It usually occurs because of the toxic alkaloids produced by the Claviceps Purpurea fungus which affects rye, barley, wheat and other cereals. The convulsion occurring owing to Ergotism will include muscle spasms, nausea, vomiting, delusions, hallucinations, crawling sensations on the skin or intense burning sensation on the skin, diarrhea, paresthesia (tingling or pricking sensation on the skin) and headaches. Other symptoms of Ergotism include gangrene due to vasoconstriction of the extremities resulting in local stagnant anoxia - occurring in toes and fingers. During the mediaeval times, ergot poisoning had taken a great toll and monks belonging to the Roman Catholic order of the St.Anthony provided effective treatment - earning the disease a sobriquet 'St.Anthony's Fire' or 'Holy Fire'.

Ergot alkaloids are derivatives of Lysergic Acid Diethylamide (LSD), and ergotism sometimes results in hallucinations of bright colors, changes in space, Formication (insects crawling under the skin) and images of marauding animals.


Recently Ergotism, Ergotoxicosis ensues after high doses of ergot alkaloids such as Ergotamine tartrate (Cafatine) and Dihydroergotamine. If it is a mild manifestation, symptoms fade away after stopping the offending drug. But severe cases can be fatal.

Hypoxia

The body needs a specific amount of Oxygen to function normally and when this amount is lowered the body experiences hypoxia. Hypoxia literally means lack of oxygen for effective ventilation.

Hypoxemia refers to a state of abnormally low level of Oxygen in the blood.
Anoxia refers to the condition of absence of Oxygen supply to an organ or tissue
Anoxemia refers to the condition where the blood stream contains below normal amount of Oxygen.


Hypoxia is primarily classified into:

Generalized hypoxia: affects the entire body, may occur in normal healthy people when they scale high altitudes.
Local hypoxia: affects one particular region of the body.

When the level of oxygen in the blood reduces, it leads to the condition. People suffering from conditions like ischemia or blockage/constriction of blood vessels may suffer from hypoxia. In general when people travel from low to high altitudes, they may face this problem as the oxygen level depletes with altitude.


Hypoxia causes

Any condition wherein the body is deprived of oxygen can lead to hypoxia. Major causes that lead to the condition include:

  • Severe head trauma
  • Ischemia
  • Asthma Severe Asthma can result in hypoxia and in Hypercarbia or Hypercapnia (elevated levels of Carbon dioxide CO2 in blood)
  • Pulmonary embolism
  • Carbon monoxide poisoning
  • Chronic alveolar hypo ventilation
  • Shock can result in cellular hypoxia in the extremities
  • Suffocation
  • Choking
  • High altitude climbing
  • Inadequate ventilation

Types of hypoxia

Hypemic hypoxia: Obstruction in the ability of the blood to deliver oxygen, caused by carbon monoxide poisoning.

Anemic Anoxia: Occurs due to a decrease in the hemoglobin or RBC making it too little for the blood to carry oxygen. Anemia may be the result of iron deficiency, hemorrhage or shortened life span of RBC owing to an autoimmune disease.

Histotoxic: When the required amount of oxygen reaches the body part, however it does not utilize it because of its reduced ability, it is called as histotoxic hypoxia. Cyanide poisoning, for example, incapacitates a cellular enzyme essential for oxygen utilization. Other causes include: Alcohol, narcotics, acetone, formaldehyde and some anesthetic agents.

Hypoxic: Also called as Hypoxemic Anoxia: When the body does not receive the required amount of oxygen it leads to low partial pressure of oxygen in the blood thus leading to hypoxic hypoxia. The oxygen pressure of the blood which gets supplied to other body tissues is too low to push and flood the hemoglobin with oxygen. High altitude has lower density of air and lower pressure of oxygen than at sea level. Altitude Sickness occurs because the partial pressure of oxygen decreases with altitude. Hypoxemia is the direct result of lower oxygen in the high altitude which translates to lower level oxygen in the blood.

Stagnant: Obstruction of blood that carries oxygen. It can be due to exposure to cold, diseases which stifle blood circulation to the extremities or ergot poisoning.


Pulse Oximetry, a non invasive test is useful to diagnose Hypoxia. A blood test like serum lactate test can show elevated levels of lactic acid - the result of starvation of oxygen in tissues. The normal level of lactic acid is less than 2 mmol/L. However an increase in lactic acid alone does not indicate hypoxia and some form of Anoxia does not increase the lactic acid concentration. Symptoms may be dangerous on the onset and may include the following:

Generalized hypoxia

  • Tachypnea or rapid breathing
  • Severe headache
  • Dizziness
  • Nausea
  • Tingling sensation
  • Visual impairment
  • Shortness of breath
  • Bluish tint on the lips or on finger tips
  • Coma
  • Seizures
  • Euphoria
  • Mental fatigue
  • Muscle fatigue


Local hypoxia
  • Hot and cold flashes
  • Discoloration of skin
  • Pain in the area of hypoxia
  • Severe hypoxia may cause gangrene

Hypoxia Treatment

Some types of Hypoxia cannot be prevented. Treatment depends on the severity of the condition and the appearance of the clinical symptoms. Treatment may include the following:

  • Restoration of the tissue oxygen by supplementing the air supply with 100 % oxygen.
  • Blood pressure and heart rate should be brought back to normal.
  • In case of high altitudes, the person should be given sufficient rest and should not climb any further.
  • Hypoxemic hypoxia patients can be put on blood transfusion.
  • Proper medication and timely treatment can help save the life.


Sumatriptan

Sumatriptan, part of the family of drugs called as triptans is prescribed for the treatment of Migraine and cluster headaches. Migraine headaches are thought to be the result of dilation of blood vessels in the head. Sumatriptan causes constriction of the blood vessels thus relieving Migraine. Triptans are technically abortive migraine medications. However, Sumatriptan does not prevent or reduce the number of migraine attacks. There is another 'triptan' drug which has slightly less side effects than Sumatriptan - Rizatriptan.

Dosage and Administration: Starting dosage may be 25 mg or at the discretion of the physician. However, the Physician might want the patient to take the first dosage at his office to monitor any adverse heart events. Normal dosage is 25 mg to 100 mg or as prescribed by the Physician. Maximum dose in any 24 hours should not exceed 300 mg orally. Do not use Sumatriptan concomitantly with Ergotamine containing preparations.

Safety and efficacy has not been proved for patients over 65 years or for children.

Contraindications: The use of Sumatriptan is contraindicated in hypersensitivity, ischemic heart disease or previous myocardial infraction, Prinzmetal's angina, coronary vasospasm and controlled hyper tension. Sumatriptan should not be used unless there is a clear diagnosis of Migraine. Before use, exclude underlying cardiac disease especially in patients with risk factors. Chest symptoms may occur which mimic angina but are rarely found to be the result of vasospasm. Vasospasm may result in arrhythmia, ischemia or myocardial infarction. This drug is to be avoided for patients with impaired renal or hepatic functions.

Sumatriptan should not be administered along with ergot type migraine medications, or with MAO inhibitors. Sumatriptan and Ergotamine together can cause prolonged spasm of the blood vessels. It is essential that the use of these two medications should be separated by at least 24 hours.

Side Effects of Sumatriptan: Pain, tingling sensation, heaviness or pressure in the chest region which may be transient. Rarely severe flushing, dizziness, Paresthesia ( unpleasant and abnormal tingling or burning in the hands, arms, feet or legs) weakness, fatigue, drowsiness may occur. Transient rise in blood pressure may occur.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019