Am J Psychiatry 2002 Jun;159(6):1061
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PMID: 12042203, UI: 22037460
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Ann Emerg Med 2002 Jun;39(6):677-9
Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0699, USA. ch2xf@virginia.edu
A 16-year-old boy presented to the emergency department with rapidly progressing extremity pain, edema, and ecchymosis after envenomation by a copperhead. Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) was infused. Six vials were placed in 250 mL of normal saline solution, and the infusion was gradually increased. Fifty minutes after beginning, the infusion was increased to 640 mL/h. Within minutes of the rate increase, the patient experienced full-body urticaria, facial edema, voice change, and tachycardia. The infusion was stopped. Hydroxyzine pamoate, famotidine, methylprednisolone, and a 1-L bolus of normal saline solution were administered intravenously. The symptoms abated, and the remaining FabAV was infused at a slower rate without return of this reaction. This immediate hypersensitivity reaction was most likely a rate-related anaphylactoid reaction that has not been previously reported with FabAV.[Holstege CP, Wu J, Baer AB. Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine). Ann Emerg Med. June 2002;39:677-679.]
PMID: 12023715, UI: 22017586
Ann Emerg Med 2002 Jun;39(6):671-6
Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego Medical Center, and the California Poison Control System, San Diego Division, San Diego, CA, USA.
Allergic reactions are the most commonly reported adverse events after administration of antivenoms. Conventional horse serum-based crotalid antivenom used in the United States (Antivenin [Crotalidae] polyvalent) can lead to both immediate and delayed hypersensitivity reactions. Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) has recently been approved for use in the United States. Experience from premarketing trials of this product and in the administration of other types of Fab, such as in digoxin poisoning, has demonstrated these fragments to be safe and effective, with a low incidence of sequella; however, allergic reactions can occur when any animal-protein derivatives are administered to human subjects. We report in detail the nature and course of allergic reactions that occurred in 4 patients treated with FabAV. Cases of anaphylaxis, acute urticaria, angioedema, and delayed serum sickness are described. All reactions were easily treated with some combination of antihistamines, epinephrine, and steroids, with prompt resolution of signs and symptoms enabling further dosing of antivenom as required. Several of these cases may have resulted from batches of antivenom contaminated with Fc fragments. The overall incidence of immediate and delayed allergic reactions to this product appears so far to be lower than that reported with conventional whole-immunoglobulin G (IgG) antivenom, but postmarketing surveillance is warranted.
PMID: 12023714, UI: 22017585
Ann Emerg Med 2002 Jun;39(6):648-50
PMID: 12023708, UI: 22017579
Ann Emerg Med 2002 Jun;39(6):616-21
San Diego Division, California Poison Control System, San Diego, CA, USA.
STUDY OBJECTIVE: We estimate how often an initially undetectable or nontoxic valproic acid (VPA) concentration misrepresents the potential toxicity of an acute VPA overdose. METHODS: All patients followed up by the San Diego and San Francisco Divisions of the California Poison Control System between January 1997 and June 1999 with a documented serum VPA concentration of 120 microg/mL or greater at any time were identified through a search of poison center databases. Cases involving patients who had serial VPA concentrations and an initial VPA concentration that was unmeasurable or less than 100 microg/mL were also identified. The methods of decontamination, clinical outcomes, highest measured concentration, and times after ingestion of the initial and highest measured concentration of VPA were determined by means of chart review for these cases. RESULTS: Of the 173 patients identified with VPA concentrations of 120 microg/mL or greater, 21 (12.1%) had a detectable initial concentration not in the toxic range, and 5 (2.9%) had initial concentrations of less than the limit of detection. These 26 cases involved acute ingestion of VPA preparations. Four of these 26 patients were discharged to home or to a psychiatric facility after the initial results were obtained. CONCLUSION: Delayed toxicity might occur in patients after an acute overdose of enteric-coated VPA. Initial serum VPA concentrations might be misleading. Serial measurements documenting declining VPA concentrations or prolonged observation are recommended to determine whether a patient is medically safe for discharge or psychiatric placement.
PMID: 12023704, UI: 22017575
Ann Emerg Med 2002 Jun;39(6):609-15
Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, AZ, USA. Michelle.Ruha@bannerhealth.com
STUDY OBJECTIVE: We describe our postmarketing experience with patients receiving Crotalidae polyvalent immune Fab (CroFab; FabAV) antivenom for treatment of rattlesnake envenomation. METHODS: The charts of 28 patients admitted between March 1 and September 9, 2001, with rattlesnake envenomation and treated with FabAV were reviewed for demographic information, time until antivenom treatment, laboratory findings, evidence of hypersensitivity reaction, length of hospital stay, and readmission to the hospital. RESULTS: All patients had swelling, 20 patients had elevated prothrombin times (>14 seconds), 12 patients had low fibrinogen levels (<170 mg/dL), and 6 patients had thrombocytopenia (platelet count <120,000/mm(3)) on presentation. The total dose of FabAV ranged from 10 to 47 vials per patient. Hypofibrinogenemia was resistant to FabAV in some patients. On follow-up, recurrence of coagulopathy was detected in 3 patients, and recurrence of thrombocytopenia was detected in 1 patient. Two patients demonstrated delayed-onset severe thrombocytopenia. Recurrence or delayed-onset toxicity might have been underestimated because of incomplete follow-up in some patients. No acute hypersensitivity reactions occurred. Two patients reported mild symptoms of possible serum sickness on follow-up. CONCLUSION: FabAV effectively controlled the effects of envenomation; however, initial control of coagulopathy was difficult to achieve in some cases, and recurrence or delayed-onset hematotoxicity was common. When initially managing hematotoxicity, a trend toward normalization of laboratory values might be a more reasonable end point for FabAV treatment than attainment of normal reference values in nonbleeding patients.
PMID: 12023703, UI: 22017574
Arch Pediatr 2002 Apr;9(4):382-4
Service de pediatrie, CHG Robert-Bisson, BP 97223, 14107 Lisieux, France. guillot.marcel@libertysurf.fr
BACKGROUND: Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity. CASE REPORT: A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5 degrees C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak. CONCLUSION: Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.
PMID: 11998424, UI: 21995439
Br J Dermatol 2002 Apr;146(4):709-10
PMID: 11966714, UI: 21963649
Br J Dermatol 2002 Apr;146(4):707-9
PMID: 11966713, UI: 21963648
Br J Dermatol 2002 Apr;146(4):643-8
Department of Dermatology, Turku University Central Hospital, 20520 Turku, Finland. kaija.lammintausta@tyks.fi
BACKGROUND: Clindamycin is an antibiotic used in anaerobic and severe complicated infections. It is often selected for patients with a history of allergy to other antibiotics. OBJECTIVES: To study the occurrence of clindamycin hypersensitivity and to determine whether skin tests are useful in cases of suspected clindamycin allergy. METHODS: Six patients with an exanthematous rash and a history strongly suggestive of clindamycin hypersensitivity were studied with skin tests and oral exposure. Cases of suspected adverse drug reactions to clindamycin reported to the National Register of Adverse Effects of Drugs (NRAED) in Finland during 1973-2000 were analysed. RESULTS: In the skin tests true-positive patch test reactions were seen in four of six patients, while 22 healthy control patients were negative. One false-positive and one false-negative patch test reaction were seen. During 1973-2000, 29 suspected cases of skin and/or mucosal membranes affected by clindamycin were reported to the NRAED. CONCLUSIONS: Clindamycin hypersensitivity is not common. Delayed-type allergic reactions occur and patch tests are useful in those cases. Oral exposure is the method of choice if possible, as false-negative and false-positive reactions may occur.
PMID: 11966697, UI: 21963632
J R Soc Med 2002 May;95(5):260-1
Bristol Eye Hospital and University of Bristol, UK.
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Lancet 2002 May 18;359(9319):1768-70
Department of Obstetrics and Gynaecology, Cairns Base Hospital, PO Box 902, Cairns 4870, Queensland, Australia. carolinedec@hotkey.net.au
PMID: 12049883, UI: 22045699
Med J Aust 2002 May 6;176(9):431-3
Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD. whitbym@health.qld.gov.au
1. Early recognition by clinicians of illnesses suggesting a biological attack is integral to the public health response. 2. The four biological agents of most concern are smallpox virus, botulinum toxin, and anthrax and plague bacteria. 3. Smallpox is distinguishable from chickenpox by the prominent prodromal period and lesions that develop at the same pace and, on any part of the body, appear identical to each other, evolve slowly and are peripherally distributed. 4. The degree of protection conferred by smallpox vaccination given 20 or more years ago is unknown. 5. Foodborne and inhalational botulism could result from deliberate release of toxin. 6. Botulism presents with cranial nerve palsies and descending paralysis in a patient with normal conscious state and no fever.
PMID: 12056996, UI: 22053451
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