Take a look at these luxury modern bathroom images to help decide which vanity cabinets, lighting, sinks, faucets, and accessories are right for your home. Photo by Shannon Ggem Design – Discover bathroom design inspiration. As long as one decorative item links the color scheme, your vintage bathroom interior will come together. This is a colonial house built in 1735 but has since been beautifully remodeled. The most budget-friendly remodel can be done for $2,500, while high-end projects can be upwards of $30,000. Browse pictures of the latest trends in walk-in shower designs. Inspiration for a small 1950s master white tile and ceramic tile cement tile floor, white floor and single-sink bathroom remodel in San Francisco with an undermount tub, a two-piece toilet, flat-panel cabinets, light wood cabinets, white walls, an integrated sink, white countertops, a niche and a floating vanity. (Image credit: Porcelain Superstore) Matching a pale wall tile with an on-trend bold wall and industrial-style matte black fixtures is a sure-fire way to make a big … The SW-110S is a relatively small bathtub with a modern curved oval design. (Image credit: Pooky) Broken plan bathroom ideas are the new, post-pandemic, practical alternative to open plan spaces. A 40-square-foot bathroom costs $4,000 – $8,000 with a separate tub and shower. Photo By: Gordon Gregory Photography 50 Small Bathroom Design Ideas & Solutions 51 Photos. “Japandi design style is up and coming, and it will carry on into 2023 and beyond. De-clutter your space like an interiors expert. Different colors help to separate the areas and … 1. Every teenage girl tries to stay ahead of trends, and nothing is more trendy this season than hot pink and mint green. A small corner by the door is usually an ideal spot for a pedestal sink - this rounded example from Studio80 suits the general feel of this beach-inspired bathroom. Browse expert-led bathroom ideas that are suited to a wide range of spaces, budgets and tastes, so you're guaranteed to find the perfect solution for your home. Small bathroom design ideas with Inspiration ideas to make your small bathroom look bigger and luxury. Its Scandinavian design meets Japanese influence - slatted wood, black wood Honest Living. This is a bright and cheerful Country-style bathroom with white wainscoting to complement the light blue walls and blend with the white wooden vanity and white freestanding bathtub by the window. Installing two task light fixtures on each side of your mirror will add functionality, and the gold hardware of the fixtures will glam up. Stark white walls, warm wood floors, and pops of color are all solidly Scandinavian in flavor in this lovely bathroom by Hawthorn and Main. but luxury vinyl can be a better and more practical idea for small bathrooms. This rounded bath tubs is a new style introduced by designers. Take a look at our collection of 18 small space ideas to inspire you and your bathroom makeover project. See more ideas about beautiful bathrooms, bathroom design, house design. Powder room - small coastal white tile and marble tile medium tone wood floor and brown floor powder room idea in Seattle with shaker cabinets, blue cabinets, gray walls, an undermount sink, quartz countertops and white countertops. Install a few tiers of open-shelving on your walls, add a few baskets for towels, fancy soaps, and a decorative accent or two and voila! Instant spa retreat. Remodeled Colonial house with spacious white bathroom with freestanding tub and shower with hardwood flooring. The bathroom mirror can also guide what size is needed. Instead, opt for green tiles and bathroom ware.
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Our goal is to test a group of well-known programs and share the absolute best so you save time exploring programs that may or may not add value to your computing life. He’ll share detailed findings of those Mac apps. Since I’m mostly on a PC, and given that some duplicate finder programs also support macOS, my teammate JP tested a number of Mac duplicate finders on his MacBook Pro. That’s when you’ll probably need a duplicate file finder app that allows you to quickly search for large, old, duplicate files and give you the option to view and delete them. You might use a service like DropBox, iCloud, or Google Drive to backup the same documents or photos that you’ve already transferred multiple times onto your laptop. I use my PC for very basic functions, it’s been a while since I’ve gone through my document and photo files and organized them. I tested twelve different duplicate file finders on my Windows 8-based laptop for this article. I have an ASUS computer, an iPhone, and a few other gadgets to do my research on. I’m just a regular user now who appreciates simple, straightforward user interfaces and programs I don’t have to fight with to make them work. I took a bunch of computer science classes in college as part of my minor and decided back then I wasn’t into coding/programming - but I love computers. How We Tested and Picked These Duplicate Finders.Some Free Duplicate File Finder Software.Also Great: Easy Duplicate Finder (macOS & Windows).Best Duplicate Finder for Windows: Duplicate Cleaner Pro.Best Duplicate Finder for Mac: Gemini 2.Best Duplicate File Finder: The Winners.You might find some of them useful as well. We also reviewed and covered a number of other duplicate finders including free software options for Windows and macOS. It’s compatible with both Windows and macOS. The app scans for duplicate files fast and accurately, and it offers two flexible views for selecting duplicates to delete. We think it’s probably the best utility that adds the most value for those who use both a PC and a Mac. There is, of course, Easy Duplicate Finder - which is also a great choice. Best of all, the DigitalVolcano team provides supporting materials and tutorials that are very helpful. It can deep scan for all types of files (photos, videos, music, documents, and more), and provides tons of customized file matching options. Besides finding exact duplicates, this powerful app can also detect similar files, which is perfect for deleting unnecessary copies of photos, videos, and backups you sync between your iPhone/iPad and Mac machine.įor those who use a Windows PC, we believe you should check out Duplicate Cleaner Pro, a program specifically designed to free up your PC hard drive by searching and deleting duplicate items. By removing those redundant files, you can free up tons of storage space on your computer’s hard drive.Īfter carefully testing and reviewing nearly twenty duplicate file finder and remover apps, we believe Gemini 2 is the best for Mac users. These apps can help detect duplicates and similar files quickly so you don’t have to spend hours, if not days, sorting them out. That’s where duplicate file finder software comes to play. Sooner or later, your computer is loaded with duplicate files which take a large amount of precious disk space, until one day you see those annoying “disk almost full” warning pop-ups. With so many different methods for file sharing and storage these days, it’s not hard to waste hard disk storage on duplicate files. It is quite difficult for many older struggling readers to feel comfortable reading a book that is recommended for children three or more years their junior, even in private. Books are designated as being appropriate for 4 and under, ages 5-7, ages 8-10 and ages 11-12. One drawback to the app that may be a downside to struggling readers is that each book has a suggested age level that is printed in an obvious location on the title page. Instead, they see a note that they need to go back and read a bit longer to earn the rewards for that book. The app also keeps young readers honest if a reader simply pages through the book, no credit is given. At the end of each book, readers are awarded with special badges showing time to read the book, number of pages completed, and so forth. They have the same page layouts and illustrations as the printed counterparts. For the price of two or three children’s books each month, users can access thousands of great titles, many of which are already probably on your children’s list of favorite books. This app has an astounding array of ebooks available at a touch of the screen. Children can rate and group books so they can easily find their favorites, or head to the library to find more fun. Parents can create separate profiles for up to four children, setting up preferences such as the reading level and genre. The app is very well-designed, with options to stream books to have instant access or download them for use off-line (a nice option for areas with slow connections or limited internet access). Awards badges to earn for reading progress QualityĮpic!-Books for Kids brings an entire library into your home, offering literally thousands of book choices for children.Recommendations from publishing experts, teachers and parents.Capable of creating personalized favorites lists.Thousands of titles available, with new ones added frequently.It’s like having an entire library at your fingertips, and will satisfy even the most voracious of readers. There is a free one-month trial to see all the app has to offer, then future months are billed through iTunes at $9.99 per month. Parents can set up to four profiles so that each child has access to a personalized library of age-appropriate favorites. In a world of unlimited screen time, Epic! is a smart alternative to generic games and videos.Epic!-Books for Kids is a subscription program that offers thousands of ebooks for children of all ages. Beautifully designed for mobile, and featuring fun, game-like elements, Epic! provides kids with a personal library-on-demand that they can take with them anywhere. Personalized for each individual reader, Epic! is the only place to access thousands of high-quality, curated children’s books without having to purchase or download titles individually. To sign up for your free educator account, please visit With an Epic! subscription, books can be easily discovered, read and shared with friends. You can sign up for a free educator account on the website using your school email address. Partnerships with leading publishers, including HarperCollins and National Geographic, bring age-appropriate, award-winning fiction and non-fiction books to your child's fingertips.Įpic is free for elementary school TEACHERS Epic!'s ever-expanding library also includes thousands of Read-to-Me books, audio books, educational videos, and fun educational quizzes. Springer, Pramawattie Kindergarten ResourceĮpic! is the world's leading online children's subscription book service offering immediate, on-demand access to over 25,000 high-quality illustrated books and chapter books for children ages 12 and under.Duran Swinford, Elizabeth (5th-7th Science).Miguel, Michelle (4th Grade Math/Science).Irving, Naheelah (Technology Coordinator).
Step 7: For the music to play over the cover art image, add the song following the steps outlined above under “How to add music to your Instagram Story.” Once you publish your Story, your followers will be able to click through your Story to the song you posted on Spotify. Step 6: Spotify will open up a new Story for you, uploading the cover art of the song, album, or playlist. You might have to give your permission to open Instagram Step 4: In the pop-up menu, navigate to Share Tap the vertical ellipsis icon on a song, album, or playlist Find the music you want to add to your Instagram Story Vibing to a song on Spotify that you think your Instagram community would like? Well, you can add music to Instagram Stories directly from Spotify. How to add music to an Instagram Story with Spotify Being able to schedule Instagram Stories in 4 simple steps is a must for busy content creators. The only problem with having so much Story inspiration is that you probably won’t want to post them all at once. If you need some visual component inspiration, here are over 30 Story ideas you can shamelessly steal! So, if you do use the workaround above, it would be beneficial for you to use a shorter clip and accompany your recording with a visual component. There should always be a visual component to your video recorded audio should not be the primary purpose of the video.For that reason, shorter clips of music are recommended.The greater the number of full-length recorded tracks in a video, the more likely it may be limited.Music in stories and traditional live music performances (e.g., filming an artist or band performing live) are permitted. Just FYI, Instagram defines its ‘general copyright guidelines’ as: If so, Instagram will remove your Story and could flag your account. You may also be on the hook for copyright infringement which Instagram is pretty strict about. It’s more of a ‘desperate times call for desperate measures’ situation. It’s not technically sanctioned by Instagram, so you won’t have the same features the app offers. Just a note, this workaround won’t show your followers the album cover or lyrics. The music playing on your phone will be included in the end result. With the song still playing, head to Instagram and record your Story. Open a music streaming app, like Spotify or Apple Music Well, good news, friend, there’s a pretty easy workaround.
In The air-fryer: In an air fryer preheated to 350☏, reheat Chicken and rice casserole for 2 to 3 minutes, or until hot throughout.Bake until hot all the way through, about 20-30 minutes. In the microwave: Place in a microwave-safe dish, and heat for 1-2 minutes. Stir together chicken, rice, soup, spices, peas and 1 cup shredded cheese in a large bowl. Stir together chicken, rice, soup, spices, peas and 1 cup shredded cheese in a large bowl.In the oven: A chicken and rice casserole can be reheated by covering it loosely with foil and baking it at 350☏ for 20 to 30 minutes.How To Reheat Chicken And Rice Casserole? In the freezer: If you tightly wrap the chicken and rice casserole, you can store it in the freezer for up to two months.In the fridge: You can store the chicken and rice casserole in the fridge for up to four days if you put it in an airtight container.These side dishes complement the casserole, providing a variety of flavors, textures, and colors for a well-rounded meal. Ina Garten Chicken And Rice Casserole What To Serve With Chicken And Rice Casserole?Ĭhicken and rice casserole can be served with steamed or roasted vegetables, a fresh green salad, crusty bread or dinner rolls, cranberry sauce, or sour cream. Pre-cooked chicken from the grocery store, leftover chicken, or rotisserie chicken are other shortcuts.This dish requires 1 1/2 pouches of rice, which equals 2 cups. Before adding Uncle Ben’s Ready Rice to the dish, microwave it as directed. Before adding them to the dish, sauté celery and onion in butter or olive oil to soften them. The casserole softens the celery and onion, but I like them crunchy.For 25-30 minutes (or until hot, bubbling, and golden on top), bake uncovered.Snapshot of the chicken and rice casserole-making procedure.Crumbs of Ritz crackers and melted butter should be mixed in a separate basin.Mixing the chicken and rice casserole’s contents.Place in the baking dish that has been oiled. Mix the chicken, rice, mayo, condensed soup, chicken broth, onion, celery, almonds, and chicken in a big bowl.Use cooking spray to coat a 9-by-13-inch baking dish, then set it aside. Turn oven temperature up to 350 degrees Fahrenheit.How To Make Ina Garten Chicken And Rice Casserole Optional garnish: chopped fresh parsley or other herbs.1 sleeve of Ritz crackers, coarsely crushed (about 30 crackers or 1 ½ cups crumbs).½ cup slivered almonds (about 2 ounces).1 (10.5 oz) can of condensed cream of chicken soup, NOT diluted (or use cream of mushroom or cream of celery soup).Ina Garten Chicken And Rice Casserole Recipe Ingredients The ingredients are mixed, topped with crushed crackers and melted butter, and baked until golden and bubbly. Ina Garten Chicken and rice casserole is a comforting dish made with cooked chicken, rice, mayo, cream of chicken soup, chicken broth, onion, celery, almonds, and Ritz crackers. Return to the freezer and store for up to 6 weeks.Ina Garten Chicken And Rice Casserole What is Ina Garten Chicken And Rice Casserole? (At this point, if desired, cut it into individual portions and wrap each one first in plastic wrap, then in foil.) Freeze for 6 to 8 hours, then unmold and wrap first in plastic wrap, then in foil. Cover with plastic wrap and refrigerate to chill through. Remove the casserole from the oven after the 30 minutes and allow it to cool. If you plan to freeze the casserole, bypass the bread crumb step. Broil for 3 to 5 minutes or until the the crumbs have lightly browned. If you plan to serve the casserole right away, uncover and sprinkle the bread crumbs evenly over the top. Cover with aluminum foil and bake for 35 minutes. Spread the chicken-rice mixture evenly in the baking dish. Use nonstick cooking oil spray to grease the inside of a 9-by-9-inch baking dish. Add the rice and stir to coat evenly.Ĭombine the 2 cups of sauce, the sour cream, lemon juice and broth in a large bowl mix well, then add the rice mixture, chicken and spinach, stirring to incorporate. Once the butter has melted, add the onion and garlic cook for about 6 minutes, stirring occasionally, until the onion is soft. The yield is 2 cups.įor the casserole: Combine the butter and oil in a medium skillet over medium heat. Stir in the cheese cook for 4 to 5 minutes, whisking to form a smooth sauce that has thickened enough to coat the back of a spoon. Slowly pour in the warm milk-broth mixture, whisking, until all of the liquid is incorporated. Whisk in the rice flour and cook for 2 minutes, whisking constantly. Melt the butter in a medium, heavy saucepan over medium heat. Microwave on MEDIUM just long enough to warm through (without boiling). For the sauce: Combine the milk and broth in a large, heat-safe measuring cup. This is a great make-ahead recipe! Prepare and cook the chicken nuggets per the instructions. The tops of the chicken nuggets will get crispy faster than the bottom, so flipping the chicken nuggets helps to get both sides crispy. When air frying chicken nuggets, I like to flip them halfway through the cooking time. If you pack too many chicken nuggets into the air fryer, the breading will fall off, they won't get crispy on the outside, and they'll take longer to cook through. The chicken nuggets should be barely touching each other. For thicker breading, dip the chicken pieces into the egg mixture then into the breadcrumb mixture, and repeat this process a second time. Tips & tricks for the best air fryer chicken nuggets. Yes, gluten free breadcrumbs and flour will work just as great! Using a ratio of 1:1 when substituting regular breadcrumbs and flour for gluten free breadcrumbs and flour. Can I use gluten free breadcrumbs and gluten free flour? If you don't have cooking spray, you can gently brush or drizzle the chicken nuggets with olive oil instead. Do I need to use oil olive cooking spray? If the chicken nuggets are fully cooked and frozen, air fry the chicken nuggets at 400✯ for about 10-12 minutes, flipping halfway through the cooking time. How long do you cook frozen chicken nuggets in the air fryer? How long do you cook chicken nuggets in the air fryer?Īdd the chicken nuggets to an air fryer in a single layer and air fry at 400✯ for about 8-10 minutes, flipping halfway through the cooking time. When air frying chicken nuggets, I recommend flipping the chicken nuggets halfway through the cooking time, as the top of the chicken nuggets will get crispy faster than the bottom. Do you flip chicken nuggets in the air fryer? Flip the chicken halfway through the cooking time. How long to cook chicken nuggets in the air fryer at 400✯ ?Īir fry chicken nuggets in a single layer at 400✯ for 8-10 minutes, or until fully cooked through. I love to serve these with honey mustard! Mix things up by adding ½ cup shredded unsweetened coconut flakes to the dry breadcrumb mixture. Mix things up and add a little Italian flare by using Italian panic breadcrumbs instead. Try using chicken breast tenderloins to create homemade chicken strips! Add ½ cup shredded or grated parmesan cheese to the dry breadcrumb mixture, adding extra flavor! If you're looking to mix things up a bit, try one of these variations! Bake at 400✯ for 10 minutes, then flip and bake another 5-10 minutes until cooked through and crispy. Prepare the chicken nuggets per the instructions, then place them on a parchment-lined baking sheet in a single layer. If you prefer, you can bake the chicken nuggets instead of using the air fryer. The full recipe is in the recipe card below. Serve! Enjoy the chicken nuggets with your favorite dipping sauce!.As you bread each piece of chicken, place it in the air fryer. This creates the thickest layer of breading. For maximum breading, transfer the chicken piece back to the egg mixture, coating all sides, then roll again in the breading. Working with one at a time, transfer the chicken pieces to the breading mixture to fully cook the chicken. Tossing the chicken pieces in the egg and milk mixture prior to dredging in breadcrumbs really helps the breading stick to the chicken. How to make Homemade Air Fryer Chicken Nuggets.Ĭooking chicken nuggets in the air fryer is my favorite because they cook so fast and always come out crispy! Here's step by step instructions. What I love about chicken nuggets is that the serving options are seriously endless! Toss the chicken nuggets with buffalo sauce to make your very own boneless buffalo wings, wrap inside of tortilla shell with your favorite fresh toppings, serve over a bed of mashed potatoes and gravy or macaroni and cheese, add to a salad, or simply serve as an appetizer with your favorite sauces for dipping! With the help of a few simple spices, the breading is flavorful and gets nice and crispy without deep frying, thanks to the air fryer! The chicken nuggets only need 10 minutes to cook, and they come out golden brown and perfectly tender.Įven better, you can make these chicken nuggets ahead of time then store in the fridge or freezer! When you're ready to serve, simply reheat in the air fryer. Homemade chicken nuggets are so easy to make and require just a small amount of oil, making them so much healthier than the frozen, deep-fried chicken nuggets you can pick up at the store. The method according to claim 5 wherein each said upright guard rail support has thereon at least one guard rail receiving means formed as an upwardly opening hook which receives an end of the guard rail therein, whereby said guard rail is then rolled about its own axis into hooking engagement to be suspended from said upright.Ĩ. The method according to claim 5 wherein the first and second clamping members are each formed by a pair of mirror image halves having flanges for receiving there in means to secure the halves together tightly engaging the respective portion of the scaffolding therebetween.ħ. Raising guard rail members to engage the guard rail supports.Ħ. Securing said second clamping member to said vertical second member of said scaffolding and Securing said first clamping member to an upper most horizontal firs member of said scaffolding with said second clamping member hanging down and said upright guard rail support projecting up above the upper most scaffolding member Īdjusting said arm connecting said first and second clamping members together such as to allow said second clamping member to engage said vertical second member of said scaffolding Providing an upright guard rail support fixed to aid extending vertically normal to the horizontal clamping axis of said first clamping assembly in cantilever fashion and having at least one guard rail receiving means thereon and Providing a length adjustable arm assembly pivotally connected at each end to a respective first and second clamping members and Providing a second clamping member for engaging an adjacent vertical second member of the scaffolding Providing a first clamping member for engaging a horizontal first member of a scaffolding A method for providing temporary guard rails on the upper most level of scaffolding, during erection and disassembly of a scaffolding comprising: The guard rail assembly according to claim 1 wherein each said upright guard rail support has thereon at least one guard rail receiving means formed as an upwardly opening hook which receives an end of the guard rail therein, whereby said guard rail is rolled about its longitudinal axis into hooking engagement to be suspended from said upright.ĥ. Means received in said flanges to secure the members together tightly engaging the respective scaffolding therebetween.Ĥ. Pairs of members adapted to be received on opposite sides of a respective portion of said scaffolding, each member having at least one lateral flange and The guard rail assembly for scaffolding according to claim 1 wherein said clamping members comprise: Means to secure the pairs of members together tightly engaging the respective portion of said scaffolding therebetween.ģ. Pairs of members adapted to be received on opposite sides of a respective portions of said scaffolding and Upright guard rail support fixed to and extending from said first clamping assembly in cantilever fashion normal to the horizontal clamping axis of said first member and having at least one guard rail receiving means thereon andĪt least one guard rail mounted on said rail receiving means.Ģ. A guard rail assembly for attachment to respective upper most horizontal and vertical portions of a scaffolding during assembly and disassembly thereof, to provide temporary fall protection for workers on the upper most level of said scaffolding, said guard rail assembly comprising:Ī first clamping member for engaging a horizontal first portion of said scaffolding Ī second clamping member for engaging an adjacent vertical second portion of the scaffolding Ī length adjustable arm member pivotally connected at each end to a respective first and second clamping member and Module and command support are basically working. You can still include local modules though. So you can include modules just by including them in the package.json. I'm currently planning on having most modules be an NPM package. You can see an example module in src/modules/. See the sample config for how to configure, then run tsc and then node bin/index.js to start the bot. Each endpoint will provide its own extra details in the event, but the basis of each event will tell you who triggered the event, and what endpoint the event came from.Ĭurrently a work in progress. For IRC, a QUIT will be mapped to every channel that user was part of as a Leave. Leave is when the user is no longer available in that channel. Join is whenever a user joins a location the bot can see (usually a channel). It understands how to join and leave channels (some endpoints don't support it).Įvery endpoint needs to emit 3 different events: Join, Leave, and Message. Various properts can be added on a per endpoint basis and used in a module, but the bot itself operates in a very abstract manner.Īn endpoint is just a connection that has a "me" object (who the bot is on this endpoint), and that's basically it. A lot of information gets abstracted out, but considering a large portion of that information isn't needed for a typical bot, it's worth the abstraction. The goal of the bot was to have a framework that can connect to multiple endpoints and work the same way regardless of the endpoint. A bot written in Typescript that connects to various chat services such as Discord, Telegram, and IRC. This ability, together with how the game decides on which ability to use, can get a bit weird. You could even make it an upgrade you can pick for any gladiator when you implement upgrades.Ĥ. Really fun to tactically play around with. I hope to see more of this mechanic where a gladiator goes for a certain class or archetype. Werewolves focusing on certain archetypes. I understand that this might make the Necromancer too powerful (I believe he summons Ghouls from corpses? I only used him once, more on that later) but I'm sure you can find a way to balance that.ģ. They probably need a buff to be more in line with other gladiators. Any fight against Ghouls is a cakewalk regardless of what class you use (except for support classes of course). The Ghoul enemy is severely underpowered. Simply have a screen that shows you what items you got, and an option to swap out items from your inventory if it is full.Ģ. There are no cases where you would not want to collect your won items besides if you have a full inventory and need to make decisions on what to keep. Most notably the Next Fight button and the Collect Items button. There is some pointless clicking in the game which could be reduced at no loss to the player. So while my suggestions mostly point at (what I consider) flaws in the game, please don't be discouraged.ġ. First, I want to preface this with that I really enjoyed the prologue and consider it to already be a very good game, which could be made into an extremely good game or even a masterpiece. So I just finished the prologue on hard permadeath and feel confident enough to spitball some ideas and thoughts on the experience. Ironically, Apixaban was reintroduced 6 days later as the patient had a suspected pulmonary embolism (PE) based on clinical signs (chest pains and breathlessness). The patient remained under medical supervision for 2 days and was then transferred to the psychiatric. Three measurements were performed during hospitalization, at 16.8, 39.7 and 70.8 h after the intake leading to plasma concentrations, estimated using the anti‐Xa activity, of 2703, 570 and 109 μg l −1, respectively. As Apixaban exposure is closely correlated to the anti‐Xa activity, the drug measurement of Apixaban is not performed 24 h/24 h in our laboratory. Indeed, it has been shown that activated charcoal administered between 2 to 6 h after intake reduces the area under the curve and half‐life at therapeutic doses 2, 3. Activated charcoal was not used because more than 6 h had passed since the drug intake. N‐acetylcysteine was initiated to prevent hepatic injury while no other medication was initiated. The first toxicological tests, carried out on admission, revealed an undetectable alcohol blood concentration and an acetaminophen plasma concentration at 86.3 mg l −1 (therapeutic trough concentrations between 5 and 25 mg l −1). The clinical examination did not show any organ dysfunctions or haemorrhagic signs, and the patient's life was not in danger. Upon admission, the patient explained that 5 h earlier, he had taken 60 tablets of Apixaban, 16 g of Acetaminophen, approximatively 10 tablets of Oxazepam and a few other drugs (not specified). His medical history included a heart attack and high blood pressure treated by beta‐blockers (bisoprolol), anticoagulant (Apixaban), antianginal drugs (Nitroglycerin and Nicorandil), diuretic (Furosemide) and statins, diabetes treated by insulin and a severe depression treated by antidepressants (Vortioxetine) and anxiolytic benzodiazepine (Oxazepam). Re-dosing of recombinant factor VIIa could be considered and titrated depending on improvement of bleeding.ĭepending on local availability, a consultation of a coagulation expert should be considered in case of major bleedings.A 67‐year‐old man with a medical history of depression was admitted to the emergency department after deliberate self‐poisoning. However, there is currently no experience with the use of recombinant factor VIIa in individuals receiving apixaban. If life-threatening bleeding cannot be controlled by the above measures, administration of recombinant factor VIIa may be considered. Thus, administration of activated charcoal may be useful in the management of apixaban overdose or accidental ingestion. Mean half-life of apixaban decreased from 13.4 hours when apixaban was administered alone to 5.3 hours and 4.9 hours, respectively, when activated charcoal was administered 2 and 6 hours after apixaban. In healthy subjects, administration of activated charcoal 2 and 6 hours after ingestion of a 20-mg dose of apixaban reduced mean apixaban AUC by 50% and 27%, respectively, and had no impact on C max. In controlled clinical trials, orally-administered apixaban in healthy subjects at doses up to 50 mg daily for 3 to 7 days (25 mg BID for 7 days or 50 mg QD for 3 days) had no clinically relevant adverse effects.Ī preclinical study in dogs demonstrated that oral administration of activated charcoal up to 3 hours after apixaban administration reduced apixaban exposure therefore, activated charcoal may be considered in the management of apixaban overdose. The initiation of appropriate treatment, e.g., surgical haemostasis or the transfusion of fresh frozen plasma should be considered. In the event of haemorrhagic complications, treatment must be discontinued and the source of bleeding investigated. Overdose of ELIQUIS may result in a higher risk of bleeding. |
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