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Am J Gastroenterol 2002 Mar;97(3):775-7
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PMID: 11922592, UI: 21919599
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Am J Psychiatry 2002 Apr;159(4):672-3
PMID: 11925312, UI: 21922553
Ann Emerg Med 2002 Mar;39(3):348
PMID: 11867998, UI: 21855862
Ann Emerg Med 2002 Mar;39(3):331-3
Department of Emergency Medicine, New York University Downtown Hospital, New York, NY, USA. tonydajer@cs.com
PMID: 11867992, UI: 21855856
Ann Emerg Med 2002 Mar;39(3):273-86
Department of Pediatric Emergency Medicine, Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH 45229, USA. randy.bond@chmcc.org
Gastrointestinal decontamination has been practiced for hundreds of years; however, only in the past few years have data emerged that demonstrate a clinical benefit in some patients. Because most potentially toxic ingestions involve agents that are not toxic in the quantity consumed, the exact circumstances in which decontamination is beneficial and which methods are most beneficial in those circumstances remain important topics of research.Maximum benefit from decontamination is expected in patients who present soon after the ingestion. Unfortunately, many overdose patients present at least 2 hours after taking a medication, when most of the toxin has been absorbed or has moved well into the intestine, beyond the expected reach of gastrointestinal decontamination. Decontamination probably does not contribute to the outcome of many such patients, especially those without symptoms. However, if absorption has been delayed or gastrointestinal motility has been slowed, activated charcoal may reduce the final amount absorbed. The use of activated charcoal in these cases may be beneficial and is associated with few complications. Therefore, administration of activated charcoal is recommended as soon as possible after emergency department presentation, unless the agent and quantity are known to be nontoxic, the agent is known not to adsorb to activated charcoal, or the delay has been so long that absorption is probably complete.The use of gastric emptying in addition to activated charcoal has generated intense debate. Several large comparative studies have failed to demonstrate a benefit of gastric emptying before activated charcoal. Because complications of such 2-step decontamination include a higher rate of intubation, aspiration, and ICU admission, gastric emptying in addition to activated charcoal cannot be considered the routine approach to patients. However, there are several infrequent circumstances in which the data are inadequate to accurately assess the potential benefit of gastric emptying in addition to activated charcoal: symptomatic patients presenting in the first hour after ingestion, symptomatic patients who have ingested agents that slow gastrointestinal motility, patients taking sustained release medications, and those taking massive or life-threatening amounts of medication. These circumstances represent only a small subset of ingestions. In the absence of convincing data about benefit or lack of benefit of gastric emptying for these patients, individual physicians must act on a personal valuation: Is it better to use a treatment that might have some benefit but definitely has some risk or not to use a treatment that has any risk unless there is proven benefit?
PMID: 11867980, UI: 21855844
BMJ 2002 Mar 30;324(7340):791
PMID: 11923174, UI: 21920331
BMJ 2002 Mar 30;324(7340):789
PMID: 11923170, UI: 21920327
BMJ 2002 Mar 16;324(7338):678
PMID: 11895840, UI: 21892633
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Forensic Sci Int 2002 Mar 28;126(1):77-81
Department of Legal Medicine, Nagoya City University Medical School, Kawasumi 1, Mizuho-ku 467-8601, Nagoya, Japan
[Record supplied by publisher]
A 65-year-old male patient who was hospitalized with schizophrenia died about 15min later after ingestion of a large volume of saponated cresol solution in a mental hospital. Fatal levels of free p- and m-cresol in the heart blood were detected at 458.8 and 957.3&mgr;g/ml, respectively, which far exceeded the fatal levels determined previously. The levels in the heart muscle, liver and spleen tissues were also extremely high, and there was 250ml of cresol-odor-emitting fluid in the stomach. The levels of glucuronic-acid-conjugated p- and m-cresols in the heart blood were 38.2 and 85.6&mgr;g/ml, respectively. Although the high levels of cresols in the heart blood may be due to diffusion from the stomach contents, it is surmised that the essential levels of free and conjugated forms in blood were at least 99 and 240&mgr;g/ml, respectively, considering the results of postmortem examinations and some case reports. It was concluded that about 340&mgr;g/ml of the total cresols was absorbed in a very short period following oral ingestion of saponated cresol solution in this case.
PMID: 11955837
Forensic Sci Int 2002 Mar 28;126(1):1-6
Department of Surgical Sciences/Forensic Medicine, University of Uppsala, Dag Hammarskjolds vag 17, S-752 37, Uppsala, Sweden
[Medline record in process]
Citalopram, a selective serotonin reuptake inhibitor, is the most frequently prescribed antidepressant in Sweden. To investigate the extent to which citalopram in overdose is found in fatal poisoning cases compared with other drugs, all fatal poisonings in one forensic medicine district in Sweden during the years 1994-1999 were examined. Drugs found in overdose in more than 10 cases were included. The ratio between number of cases with each included drug and prescription of defined daily dose/1,000 inhabitants/day (DDD) was determined.Citalopram was the fourth most frequently found drug in overdose, occurring in 22 (6%) of the 358 fatal poisoning cases, after dextropropoxyphene (DXP), flunitrazepam and nitrazepam, which were present in 111 (31%), 56 (16%) and 31 (9%) cases, respectively. When related to the prescription rate, citalopram was significantly less represented than five of the other seven included drugs, namely DXP, flunitrazepam, nitrazepam, amitriptyline and clomipramine. Propiomazine and zopiclone occurred to the same extent as citalopram. According to the assessments of the forensic physicians, citalopram was the cause of death in five cases (1.4%) and contributed to death in another nine cases (2.5%).It is concluded that citalopram, in spite of its high prescription rate, has not become a drug of importance in fatal poisoning cases. Since, this result may not be generalisable to non-fatal poisoning cases, it is recommended that the prevalence of citalopram in these cases be examined separately.
PMID: 11955823, UI: 21952776
Hum Exp Toxicol 2001 Nov;20(11):569-75
Human Anatomy Department, Medical University of Lublin, Poland.
The common effects of acetaminophen (APA), isopropylantipyrine (IPA) and caffeine on liver were examined in rats. The preparations were given in Tween-80 solution once daily, in a constant proportion of 5:3:1, during days 8 to14 of gestation (S1, S2, S3 groups) or between days 8 and 14 of the experiment in nonpregnant female Wistar rats (S1-NP, S2-NP, S3-NP groups). The administration was in three different doses: doses S1, S1-NP-3.5 mg/kg APA, 2.14 mg/ kg IPA, 0.7 mg/kg caffeine; doses S2, S2-NP were 10 times higher; and doses S3, S3-NP 100 times higher than doses S1, S1-NP There were two control groups (T, T-NP) with Tween-80. At day 21 of gestation/experiment blood was taken for determination of activity of alanine (ALA) and aspartate (AST) aminotransferase, lactate (LDH) and glutamate (GLDH) dehydrogenase, levels of bilirubin (BIL), urea (URE), total protein (TP) and thymol turbidity test (TTT). The liver sections were examined by light microscopy with four stains: hematoxylin and eosin (H+E), silver Gomori, van Gieson and periodic acid-Schiff (PAS). There was a statistically significant (P<0.05) increase in the GLDH (S3-NP, S2, S3 groups) and AST, LDH (S3 group) activity, a decrease in URE (S2, S3 groups) and decrease in TP (S3-NP, S2, S3 groups) compared to the corresponding control group. Significant differences were noted in activity of AST, GLDH, and levels of the URE and TP between pregnant and nonpregnant females. The treatment resulted in minimal reactive and degenerative changes in light microscopic pattern of liver.
PMID: 11926611, UI: 21923571
Int J Dermatol 2002 Jan;41(1):50-1
Department of Dermatology, San Gerardo Hospital, Monza, Italy. albertoschiera@tiscalinet.it
PMID: 11895516, UI: 21893158
J Emerg Med 2002 Feb;22(2):213-4
PMID: 11858933, UI: 21848207
J Emerg Med 2002 Feb;22(2):207-8
Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103-8676, USA.
PMID: 11858930, UI: 21848204
J Emerg Med 2002 Feb;22(2):199-201
Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
PMID: 11858928, UI: 21848202
J Emerg Med 2002 Feb;22(2):185-8
St. Joseph's Regional Medical Center, Paterson, New Jersey 07503, USA.
Hypermagnesemia is a rare cause of coma in a patient with normal renal function. When present, it is often because of iatrogenic medication overdose. We report a fatal case of chronic Epsom salt gargles for halitosis that produced a serum magnesium of 23.6 mg/dL (9.8 mmol/L) and resulted in coma. We review the wide presentation of hypermagnesemia from subtle neurologic and cardiovascular signs to the major life-threatening clinical manifestations of shock, dysrhythmias, coma, and cardiopulmonary arrest despite emergency dialysis.
PMID: 11858925, UI: 21848199
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