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Ann Pharmacother 2002 Feb;36(2):344-5
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PMID: 11847960, UI: 21837602
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Ann Pharmacother 2002 Feb;36(2):331-3
Department of Pharmacy, University of Kentucky Chandler Medical Center, Lexington, KY, USA.
OBJECTIVE: To evaluate the literature regarding the potential of acetaminophen to cause toxicity in adult patients without risk factors, when used chronically in daily doses < or = 4 g. DATA SOURCES: Key tertiary literature was reviewed, along with searches of MEDLINE (1966-July 2001). International Pharmaceutical Abstracts (1970-May 2001), and PREMEDLINE (July Week 5, 2001). Key search terms included acetaminophen, paracetamol, toxic hepatitis, hepatotoxicity, liver dysfunction, overdose, drug toxicity, and poisoning. DATA SYNTHESIS: Most tertiary references state that the maximum daily dose of acetaminophen is 4 g. Patients taking more than this amount, especially those with certain risk factors, are more likely to develop toxicity. However, a few patients may develop toxicity regardless of risk. An evaluation of the literature regarding the toxic potential of acetaminophen when given at doses < or = 4 g/d chronically (> or = 4 d) to adult patients without risk factors was conducted. CONCLUSIONS: Acetaminophen should be used cautiously on a chronic basis because several case reports show that it may be hepatotoxic at therapeutic doses.
PMID: 11847957, UI: 21837599
Ann Pharmacother 2002 Feb;36(2):261-3
Department of Internal Medicine C, Kaplan Medical Center, Rehovot 76100, Israel. stevash@trendline.co.il
OBJECTIVE: To report a case of acute cholestatic hepatitis following exposure to the inhalational anesthetic isoflurane. CASE SUMMARY: A 70-year-old healthy woman from Iraq developed acute cholestatic hepatitis 3 weeks following repair of the right rotator cuff under general anesthesia. There was no evidence for viral, autoimmune, or metabolic causes of hepatitis. No other medications were involved except for dipyrone for analgesia. The alanine aminotransferase was elevated to a peak concentration of 1533 U/L and the serum bilirubin reached a peak of 17.0 mg/dL. There was slow improvement over 4 months. Accidental reexposure by the patient to dipyrone was uneventful. DISCUSSION: The clinical and histologic picture of this case resembles halothane hepatitis, which has a significant mortality rate. CONCLUSIONS: Isoflurane, a common anesthetic agent, can cause severe cholestatic hepatitis.
PMID: 11847945, UI: 21837587
Dermatology 2002;204(3):248-50
Department of Allergology, Policlinico 'A. Gemelli', Universita Cattolica del Sacro Cuore, Roma, Italia.
Corticosteroids are drugs that may cause allergic contact dermatitis, but systemic allergic reactions to these drugs are rare. A 29-year-old man developed a maculopapular rash during an oral therapy with betamethasone. Patch tests demonstrated a delayed-type allergy to dexamethasone, betamethasone and fluocortolone. Oral, intramuscular or topical provocation tests with other corticosteroids - deflazacort, hydrocortisone, methylprednisolone, fluticasone dipropionate, triamcinolone and prednisone - were all negative. This demonstrates that a patient with a systemic allergy to a group of corticosteroids can tolerate those of other groups. Copyright 2002 S. Karger AG, Basel
PMID: 12037457, UI: 22032846
Forensic Sci Int 2002 Jul 17;127(3):208
Forensic Chemistry Laboratory, Department of Health, P.O. Box 1080, 2000, Johannesburg, South Africa
[Record supplied by publisher]
A method, based on reversed phase high performance liquid chromatography (HPLC) was developed for the detection and quantification of anabasine, the toxic alkaloid of Nicotiana glauca, in forensic applications. A standard solid phase extraction (SPE) method was used for the extraction of anabasine from viscera, but was optimized for the extraction of this alkaloid from plant material. The careful selection of mobile phase components allowed the direct coupling of electron impact (EI) and Z spray mass selective detector (ZMD) of the HPLC. Under these conditions, anabasine was well separated from nicotine and could be detected on the PDA (limit of detection, LOD=250ng/ml), TMD (LOD=10&mgr;g/ml) and ZMD (LOD=1ng/ml) detectors. Three geographically isolated N. glauca trees were analyzed for alkaloid content and it was found that both the leaves and the flowers contain anabasine. The optimized HPLC method was used to analyze two viscera samples (the stomach and contents of a mother and child who putatively died from food poisoning) and a flower exhibit. Anabasine was detected in both the viscera samples, supporting the finding that these fatalities were due to the ingestion of N. glauca accidentally collected with traditional spinach (marog). The alkaloid profile of the flower exhibit submitted with the viscera samples was similar to those obtained from flowers collected from three different N. glauca trees. The results show that anabasine and/or N. glauca poisoning can easily be confirmed using the forensic methodology described.
PMID: 12175951
Forensic Sci Int 2002 Aug 28;128(3):123
Toxicology Unit, Department of Chemical Pathology, University of the Witwatersrand Medical School, 7 York Road, Parktown 2193, Gauteng, South Africa
[Medline record in process]
A child who had been treated orally with a traditional medicine was admitted to hospital with diarrhoea, vomiting and severe metabolic acidosis. Following treatment for renal failure and supportive therapy, the child was discharged well. Analysis of the traditional remedy, a black powder, using inductively coupled plasma-optical emission revealed very high concentrations of iron and manganese. Other metals were also present at lesser, but still high concentrations. The composition suggested that this was a sample obtained from a surface fracture in Transvaal dolomite.Metal poisoning is not uncommon following the use of non-herbal traditional remedies in South Africa, but in this case the mixture appears to have been a combination of many metals and salts.
PMID: 12175791, UI: 22166108
JAMA 2002 Aug 7;288(5):604-10
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. BuchholzU@rki.de
CONTEXT: On January 5, 1999, the California Department of Health Services was notified of the repeated occurrence (December 21, 1998, and January 2, 1999) of gastrointestinal tract illness among patrons at a Thai restaurant in central California. OBJECTIVE: To identify the source of the outbreak. DESIGN: Case-control study; microbiological and toxicological laboratory testing of samples of food, stool, and vomitus. SETTING: Thai food restaurant in central California. PARTICIPANTS: Patrons of the restaurant. A case (n = 107) was defined as dizziness, nausea, or vomiting occurring in a person who ate at the restaurant between December 20, 1998, and January 2, 1999, with onset of symptoms within 2 hours of eating. A control (n = 169) was a person who ate at the restaurant during the same period but reported no symptoms. MAIN OUTCOME MEASURES: Odds ratios (ORs) of illness associated with food exposures; ORs of shifts during which illness occurred associated with certain cooks; laboratory results. RESULTS: The median latency period was 40 minutes from beginning eating to first symptom and was 2 hours to onset of diarrhea. The median duration of symptoms was 6 hours. Twenty-six persons (24%) visited the emergency department or were treated by a physician; no person required hospitalization. Patients reported nausea (95%), dizziness (72%), abdominal cramps (58%), headache (52%), vomiting (51%), chills (48%), and diarrhea (46%). Fifty-one cases (48%) included dizziness, lightheadedness, or a feeling of disequilibrium as the initial symptom. Illness was statistically associated with several foods and ingredients, but no single dish or ingredient explained a substantial number of cases. The analysis of food exposures included salt added by cooks, as estimated by using the amount of salt in the recipe for each dish and the amount of each dish eaten by respondents. This association was stronger with increasing levels of salt: ORs for illness among persons who consumed more than 0.42 to 0.84, more than 0.84 to 1.25, and more than 1.25 tsp of salt added to foods in the kitchen were 1.9 (95% confidence interval [CI], 0.6-5.7), 3.0 (95% CI, 1.0-8.8), and 4.0 (95% CI, 1.3-13.5) compared with persons who consumed less than 0.42 tsp (P value for trend =.004). Methomyl, a highly toxic carbamate pesticide, was identified in a sample of vomitus (20 ppm) and in salt taken from containers in the storeroom (mean, 5600 ppm) and the stovetop (mean, 1425 ppm). The oral toxic dose causing illness in 50% of those exposed to methomyl was estimated to be 0.15 mg/kg of body weight (estimated range, 0.09-0.31 mg/kg of body weight). The presence of cook A was associated with shifts during which cases of illness occurred (OR, 10.4; 95% CI, 1.2-157.4). CONCLUSION: This outbreak of gastrointestinal illness was associated with the consumption of food seasoned with methomyl-contaminated salt. To allow rapid assessment for further investigational and control measures by health officials, physicians should report suspected outbreaks of illness to public health departments, however trivial the symptoms or cause may seem.
PMID: 12150672, UI: 22146464
Med J Aust 2002 Aug 19;177(4):193-5
Pharmacy Department, Women's and Children's Hospital, North Adelaide, SA, Australia.
A preterm infant born to a woman with chronic lead poisoning was found to have the highest blood lead level recorded for a surviving neonate. Parenteral calcium disodium edetate, but not oral succimer, was effective in reducing the infant's lead burden in the neonatal period. An exposure assessment revealed the mother's long-term ingestion of lead-contaminated herbal tablets as the source.
PMID: 12175323, UI: 22167010
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