Ann Emerg Med 2002 Mar;39(3):312-5
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.
[Medline record in process]
Most reported cases of inorganic mercury poisoning are from mercuric chloride. We report a case of mercuric oxide (HgO) powder ingestion. A 31-year-old man presented to an emergency department after ingestion of approximately 40 g of HgO. Soon after ingestion, he developed nausea, vomiting, and abdominal cramping. Abdominal radiograph revealed densely radiopaque material in the stomach. Gastrointestinal decontamination was accomplished with activated charcoal and whole-bowel irrigation with polyethylene glycol solution (Golytely) for 24 hours until repeat abdominal radiographs no longer demonstrated the substance in the gastrointestinal tract. He was also chelated with British anti-Lewisite for 5 days, followed by succimer for 10 days. He had markedly elevated urine and blood mercury levels after ingestion, but except for a mildly depressed serum bicarbonate (19 mEq/L), his chemistry results remained normal including blood urea nitrogen and creatinine. He had an uncomplicated hospital course and remained asymptomatic at 6 months postingestion. Despite elevated urine and blood mercury levels after ingestion of HgO, our patient did not develop the end-organ toxicity typical of inorganic mercury poisoning.
PMID: 11867987, UI: 21855851
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Ann Emerg Med 2002 Mar;39(3):307-11
Department of Emergency Medicine and Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN.
Thallium and arsenic have been used as a means of criminal poisoning. Although both manifest characteristically with peripheral neuropathies, thallium is associated with alopecia and arsenic with gastrointestinal symptoms. We describe the symptoms, physical findings, diagnostic test results, and outcomes in a group of men poisoned with thallium and arsenic. Seven patients had evidence of elevated thallium levels, and 2 patients had elevated arsenic and thallium levels. The most commonly reported symptoms included myalgias, arthralgias, paresthesias, and dysesthesias. Five patients developed alopecia. All patients with symptoms and peripheral neuropathies had characteristic blackening of their hair roots. Initially treated with dimercaptosuccinic acid, patients were switched to multiple-dose activated charcoal after testing revealed thallium poisoning. By 6 months, all patients' symptoms and peripheral neuropathies improved, but 5 patients had ongoing psychiatric problems. Thallium remains a means of criminal poisoning and should be considered in any patient with a rapidly progressing peripheral neuropathy with or without alopecia.
PMID: 11867986, UI: 21855850
BMJ 2002 Feb 9;324(7333):332-5
Defence Science and Technology Laboratories, Porton Down, Salisbury, Wiltshire, SP4 0JQ.
Publication Types:
PMID: 11834561, UI: 21823337
JAMA 2002 Feb 20;287(7):869-74
Department of Pediatrics, New York University Medical Center, 550 First Ave, New York, NY 10016, USA.
A 7-month-old infant with cutaneous anthrax developed severe systemic illness despite early treatment with antibiotics. The infant displayed severe microangiopathic hemolytic anemia with renal involvement, coagulopathy, and hyponatremia. These findings are unusual with cutaneous anthrax, but have been described in illness resulting from spider toxin and may delay correct diagnosis. The systemic manifestations of the disease persisted for nearly a month despite corticosteroid therapy, but resolved.
PMID: 11851579, UI: 21841507
Pediatr Emerg Care 2002 Feb;18(1):36-37
Departments of Emergency Medicine, University of Massachusetts-Memorial Health Center, Worcester, Massachusetts (E.W. Boyer).
[Record supplied by publisher]
PMID: 11862138
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