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[Prurigo]
[Article in French]
Prigent F.
Consultation de dermatologie, hopital Saint-Michel, 33, rue Olivier-de-serres, 75015 Paris, France.
PMID: 14643555 [PubMed - indexed for MEDLINE]
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The Kaprun cable car fire disaster--aspects of forensic organisation following a mass fatality with 155 victims.
Meyer HJ.
Institute of Forensic Medicine, Salzburg University, Ignaz Harrerstr. 79, A-5020 Salzburg, Austria. harald.meyer@sbg.ac.at
In November 2000, a tunnel-bound cable car in Kaprun caught fire, with the subsequent death of 155 persons. No passenger list was in existence and bodies were burnt to such an extent that morphological identification was not feasible. A full post-mortem examination was performed on all bodies. All bodies were positively identified within 19 days after the incident by DNA analysis. Cause of death was determined to be carbon monoxide poisoning in combination with suffocation due to inhalation of smoke. The organisational aspects of processing are portrayed.
PMID: 14642713 [PubMed - indexed for MEDLINE]
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Prevalence of autonomic signs and symptoms in antimuscarinic drug poisonings.
Patel RJ, Saylor T, Williams SR, Clark RF.
Division of Medical Toxicology, Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103-8676, USA.
Classically described antimuscarinic poisoning signs and symptoms include mydriasis, decreased secretions, ileus, urinary retention, hyperthermia, tachycardia, and altered mental status. These features may be used clinically to assist in the diagnosis of patients with unknown poisonings. We sought to analyze the prevalence of antimuscarinic physical examination findings in evaluating patients presenting with acute poisoning from antimuscarinic agents. We conducted a retrospective, medical record review at two urban tertiary care teaching hospitals. The study population consisted of patients presenting to the Emergency Department with a diagnosis of acute poisoning secondary to medications with known antimuscarinic side effects during a 78-month period between January 1994 and July 2001. Cases were excluded for incomplete medical records or unreliable histories of ingestion, and when concomitant ethanol intoxication was present on laboratory analysis. Clinical information obtained from each patient included vital signs, pupillary size, electrocardiogram abnormalities, the presence of mucous membrane and axillary secretions, initial urine output after bladder catheterization, quality of bowel sounds, mental status changes, the occurrence of seizures and coma, need for orotracheal intubation, and time required for clinical resolution. Diagnostic and therapeutic information including laboratory tests, administration of sodium bicarbonate, and usage of physostigmine was also collected. We identified a total of 345 cases, 213 of which met inclusion criteria. Of these cases, the most common documented findings included decreased secretions in 75.1%, tachycardia in 68.1%, confusion in 49.3%, drowsiness in 48.2%, and hypoactive or absent bowel sounds in 44.6%. Combining signs and symptoms to predict this toxic syndrome was not very reliable. Tachycardia, decreased oral or axillary secretions, and mydriasis proved to be the most predictive trio of clinical signs, but were found in only 28.2% of cases. At least one of these three signs was documented in 94% of our patients. The combination of tachycardia and decreased secretions was the most common pair of findings, recorded in 55.4% of cases. We conclude that the clinical presentation of antimuscarinic syndrome is variable.
PMID: 14751484 [PubMed - in process]
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Mirtazepine overdose and miosis.
Langford NJ, Ferner RE, Patel H, Munyame C, Hamlyn AN.
Publication Types:
PMID: 14705856 [PubMed - indexed for MEDLINE]
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A fatal case of metformin poisoning.
Nisse P, Mathieu-Nolf M, Deveaux M, Forceville X, Combes A.
Publication Types:
PMID: 14705855 [PubMed - indexed for MEDLINE]
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Role of laboratory in the management of phenylbutazone poisoning.
Virji MA, Venkataraman ST, Lower DR, Rao KN.
Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
We report a rare case of intentional overdose of phenylbutazone in a 15-yr-old female. The patient exhibited symptoms of phenylbutazone toxicity and the presence of the drug was confirmed by gas chromatography mass-spectrometry (GC-MS) analysis of the initial urine sample. The patient underwent plasmapheresis to remove the drug from the circulation. Semiquantitation of sequential serum samples by GC-MS revealed elimination of phenylbutazone by day 5 of admission at which time the plasmapheresis was discontinued. Elevated blood urea nitrogen (BUN) and creatinine returned to normal. Analysis of biomarkers for liver necrosis and regeneration in sequential serum samples revealed the restoration of normal liver function by day 5. This case further confirms our previous observations that biomarkers for liver necrosis and regeneration can predict the outcome of patients with liver damage due to toxins.
Publication Types:
PMID: 14705852 [PubMed - indexed for MEDLINE]
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Hornet sting induced systemic allergic reaction and large local reaction with bulle formation and rhabdomyolysis.
Lin CC, Chang MY, Lin JL.
Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC. bearuncle@yahoo.com
A 41-yr-old, previously healthy male was stung once by a hornet. The patient had no history of allergy or hornet stings. Physical examination revealed swelling of the right side of his body with blister formation on the extremities. Rhabdomyolysis developed. Treatment included corticosteroids, antihistamines, and cyproheptadine. The patient was discharged without sequellae after being hospitalized for 7 days.
Publication Types:
PMID: 14705851 [PubMed - indexed for MEDLINE]
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Massive caffeine overdose requiring vasopressin infusion and hemodialysis.
Holstege CP, Hunter Y, Baer AB, Savory J, Bruns DE, Boyd JC.
Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia 22908-0699, USA. ch2xf@virginia.edu
INTRODUCTION: Massive caffeine overdose is associated with life-threatening hemodynamic complications that present challenges for clinicians. We describe the highest-reported serum concentration of caffeine in a patient who survived and discuss the first-reported use of vasopressin and hemodialysis in a caffeine-poisoned patient. CASE REPORT: A 41-yr-old woman presented 3 h after ingesting approximately 50 g of caffeine. She subsequently underwent cardiopulmonary resuscitation and received multiple medications in an attempt to raise her blood pressure and control her heart rate without success. Vasopressin infusion increased her blood pressure to the point where hemodialysis could be performed. Despite ensuing multisystem organ failure, she survived and has made a complete recovery. CONCLUSION: Hemodialysis and vasopressin infusions may be of benefit in the management of caffeine-intoxicated patients who fail to respond to standard therapies.
Publication Types:
PMID: 14705850 [PubMed - indexed for MEDLINE]
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Massive venlafaxine overdose resulted in a false positive Abbott AxSYM urine immunoassay for phencyclidine.
Bond GR, Steele PE, Uges DR.
Drug and Poison Information Center, Department of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. randy.bond@cchmc.org
CASE REPORT: A 13-yr-old girl overdosed on 48 x 150 mg venlafaxine (Effexor XR). She was taking venlafaxine regularly for depression. Her only other medications included topical Benzamycin and pyridoxine 50 mg daily for acne. The Abbott AxSYM assay was positive only for phencyclidine, but GC/MS did not confirm the presence of phencyclidine. Toxilab identified only one substance, confirmed by GC/MS as venlafaxine. A serum sample obtained 3 h after her ingestion revealed a venlafaxine concentration of 24460 ng/mL and an O-desmethylvenlafaxine concentration of 3930 ng/mL, confirming the massive acute overdose (therapeutic range of venlafaxine and O-desmethylvenlafaxine together is 250-750 ng/mL). Urine spiked with 4.2 mg/mL ofvenlafaxine and 0.7 mg/mL of O-desmethylvenlafaxine was interpreted as positive with the Abbott AxSYM fluorescent polarized immunoassay for phencyclidine (readout of 28 ng/mL). CONCLUSION: Venlafaxine may cause a false positive Abbott AxSYM phencyclidine assay when present in very high concentrations. Physicians should be aware of this potential reaction when interpreting urine drug immunoassays.
Publication Types:
PMID: 14705849 [PubMed - indexed for MEDLINE]
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Status epilepticus from an illegally imported Chinese rodenticide: "tetramine".
Barrueto F Jr, Furdyna PM, Hoffman RS, Hoffman RJ, Nelson LS.
New York City Department of Health and Mental Hygiene, New York City Poison Control Center, New York, New York 10016, USA. fbarr001@umaryland.edu
INTRODUCTION: The following case report demonstrates the severe consequences of refractory convulsive status epilepticus from an unfamiliar imported toxin, tetramethylenedisulfotetramine (TETS), and the difficulties of identifying the offending agent. CASE REPORT: A previously healthy 15-month-old girl was found by her parents playing with a white rodenticide powder brought from China. Fifteen minutes later, the child developed generalized seizures and was brought to an Emergency Department (ED). Her initial fingerstick blood glucose was 108 mg/dL. In the ED, the child was intubated for status epilepticus. Despite aggressive therapy with lorazepam, phenobarbital, and pyridoxine, she had 4 h of intermittent generalized seizure activity. She was extubated on the third hospital day, but appeared to have absence seizures and cortical blindness. Continuous electroencephalogram monitoring, performed weeks later, revealed severe diffuse cerebral dysfunction with multiple epileptogenic foci. The child remains developmentally delayed and is on valproic acid therapy for seizure control. Translation of the Chinese package labeling did not clarify its contents. Tetramethylenedisulfotetramine was finally confirmed by gas chromatography-mass spectrometry (GC-MS) in this rodenticide product and then quantified against a TETS standard that was synthesized in our laboratory. CONCLUSION: Tetramethylenedisulfotetramine is grouped with other "cage convulsants," such as picrotoxin, since they have a similar intercalating cyclical molecular structure and cause seizures through non-competitive gamma-aminobutyric acid (GABA) antagonism. The oral lethal dose 50% (LD50) in humans is estimated to be as low as 100 microg/kg. Our patient has severe diffuse cerebral dysfunction likely secondary to prolonged seizure activity after exposure to TETS.
Publication Types:
PMID: 14705847 [PubMed - indexed for MEDLINE]
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Acute topiramate toxicity.
Traub SJ, Howland MA, Hoffman RS, Nelson LS.
The Division of Toxicology, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. straub@bidmc.harvard.edu
Topiramate (Topamax) is an anti-epileptic medication for which acute toxicity is infrequently reported. A 5-yr-old girl, not previously taking topiramate, developed neurological symptoms after acute ingestion of this medication. She was intermittently agitated, complained of "not being able to feel anything," demonstrated arching movements of the back, and perseverated upon questioning. Computerized tomography of the head and electroencephalography were both normal, and urine toxicology testing for drugs of abuse was negative. A serum topiramate level was 10.5 mcg/mL, confirming the ingestion. The patient was observed for 24 h, over which time her symptoms completely resolved.
Publication Types:
PMID: 14705846 [PubMed - indexed for MEDLINE]
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Comparison of the fatal toxicity index of zopiclone with benzodiazepines.
Reith DM, Fountain J, McDowell R, Tilyard M.
Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. david.reith@stonebow.otago.ac.nz
BACKGROUND: Zopiclone is a hypnosedative structurally unrelated to the benzodiazepines but operating at the same receptor complex. Although zopiclone has been used in clinical practice for many years, relatively little is known of its relative toxicity in comparison with other hypnosedatives. METHOD: Deaths, where hypnosedatives were implicated, in New Zealand (NZ) in 2001 were identified from a chemical injury database. Prescription and aggregate defined daily dose (DDD) data forNZ in 2001 were obtained from a national prescribing database. Rates of death per prescription and DDD, and relative rates between individual hypnosedatives and benzodiazepines, and their respective 95% CI were calculated. RESULTS: Of the 200 poisoning deaths in NZ for 2001, 39 involved hypnosedatives, and zopiclone was involved in 12. Hypnosedatives were the sole agents in only one death and were the primary agents in eight deaths. Zopiclone was the sixth most commonly involved agent in poisoning deaths in NZ in 2001. The relative rate of death per prescription (95% CI) and DDD (95% CI) of zopiclone compared with benzodiazepines were 1.04 (0.49-2.05) and 0.59 (0.28-1.16), respectively. The relative rates of death per DDD (95% CI) for alprazolam and chlormethiazole compared with the other sedatives/anxiolytics were 6.2 (1.6-17.0) and 20.9 (2.5-79.8) respectively. CONCLUSIONS: The fatal toxicity for zopiclone was not significantly different from that for benzodiazepines as a group when adjusted for usage, whereas alprazolam and chlormethiazole had greater toxicity. Hypnosedatives are contributory factors rather than primary substances in poisoning deaths.
PMID: 14705844 [PubMed - indexed for MEDLINE]
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An outbreak of food-borne illness due to methomyl contamination.
Tsai MJ, Wu SN, Cheng HA, Wang SH, Chiang HT.
Institute of Basic Medical Sciences, National Cheng Kung University Medical College, Tainan City, Taiwan, ROC.
BACKGROUND: On December 26, 2002, 124 dinners took ill while eating lunch at a seafood restaurant in the town of Chiching in Kaohsiung municipality of Taiwan. Sixty-nine people were sent to the emergency departments of the Municipal Chiching Hospital and Yuan's General Hospital. METHODS: We analyzed the clinical symptoms, detailed food history, and ingested amount of each food from 59 hospitalized adult patients and identified the source of the outbreak. RESULTS: The median latency period from beginning eating to first symptoms was 5 min. Twenty-six symptoms and signs were recorded. The most commonly reported clinical effects were general weakness (84%), ataxia (82%), dizziness (82%), vomiting (80%), sweating (75%), floating sensation (71%), headache (69%), dyspnea (69%), and blurred vision (67%). Thirty-one patients had residual symptoms 7 days after ingestion. Of the six residual symptoms reported, the most frequent ones were dizziness (40%), poor appetite and dry mouth (11%), and gastrointestinal disturbance (11%). The presence of residual symptoms correlated with the severity of the initial complaints (p < 0.01). Almost all patients ate cooked rice (93%) and leaf vegetable stir-fried with crab claw (93%). The amount of each food eaten by the patients was not associated with the severity of symptoms (p > 0.05). High levels of methomyl in leaf vegetables of "leaf vegetables stir-fried with crab claws" (380 ppm) and fried mussels (1113 ppm) were found by the Food Inspection Center at the Department of Health. The food history and chemical analysis of the poison indicated methomyl was the cause of this outbreak. Twenty-four patients recovered completely within 7 days. CONCLUSION: Food-related methomyl intoxication produced a rapid onset of significant clinical toxicity in 124 individuals. Based on the analysis of 55 adult patients, the most common effects were gait ataxia, dizziness, generalized weakness, and vomiting.
PMID: 14705843 [PubMed - indexed for MEDLINE]
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Arsenic toxicity from homeopathic treatment.
Chakraborti D, Mukherjee SC, Saha KC, Chowdhury UK, Rahman MM, Sengupta MK.
School of Environmental Studies, Jadavpur University, Kolkata, India. dcsoesju@vsnl.com
Homeopathic medicine is commonly believed to be relatively harmless. However, treatment with improperly used homeopathic preparations may be dangerous. CASE REPORTS: Case 1 presented with melanosis and keratosis following short-term use of Arsenic Bromide 1-X followed by long-term use of other arsenic-containing homeopathic preparations. Case 2 developed melanotic arsenical skin lesions after taking Arsenicum Sulfuratum Flavum-1-X (Arsenic S.F. 1-X) in an effort to treat his white skin patches. Case 3 consumed Arsenic Bromide 1-X for 6 days in an effort to treat his diabetes and developed an acute gastrointestinal illness followed by leukopenia, thrombocytopenia, and diffuse dermal melanosis with patchy desquamation. Within approximately 2 weeks, he developed a toxic polyneuropathy resulting in quadriparesis. Arsenic concentrations in all three patients were significantly elevated in integument tissue samples. In all three cases, arsenic concentrations in drinking water were normal but arsenic concentrations in samples of the homeopathic medications were elevated. CONCLUSION: Arsenic used therapeutically in homeopathic medicines can cause clinical toxicity if the medications are improperly used.
Publication Types:
PMID: 14705842 [PubMed - indexed for MEDLINE]
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Detection and quantitation of xenobiotics in biological fluids by 1H NMR spectroscopy.
Imbenotte M, Azaroual N, Cartigny B, Vermeersch G, Lhermitte M.
Laboratoire de Toxicologie, Faculte des Sciences Pharmaceutiques et Biologiques, Lille, France. mimbenot@pharma.univ-lille2.fr
NMR spectroscopic investigation can be applied to a large variety of xenobiotics in acute poisoning cases (therapeutic agents, pesticides, solvents, alcohols). In a salicylate poisoning case, the three major metabolites of acetylsalicylic acid--salicylic, salicyluric, and gentisic acids--have been detected in crude urine. Valproic acid as glucuronoconjugated form was identified in urine samples from two poisoned patients. Paraquat (Gramoxone) was identified by its two aromatic signals at 8.49 and 9.02 ppm and quantitated in urine of two acutely poisoned patients (985 and 500 micromol/L). In an intentional poisoning case with tetrahydrofuran, this compound was characterized by its resonances at 1.90 and 3.76 ppm, and quantitated at 11.3 and 11.8 mmol/L in serum and urine samples, respectively. Methanol, ethylene glycol, and the corresponding metabolites formate and glycolate were detected in the same spectrum of serum samples from three poisoned patients. Detection and quantitation of many exogenous and endogenous compounds could be achieved by 1H HMR spectroscopy in biological fluids without any hypothesis on the chemical species.
PMID: 14705841 [PubMed - indexed for MEDLINE]
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Do co-intoxicants increase adverse event rates in the first 24 hours in patients resuscitated from acute opioid overdose?
Mirakbari SM, Innes GD, Christenson J, Tilley J, Wong H.
Department of Emergency Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. smm@fastmail.ca
BACKGROUND: Patients frequently arrive in emergency departments (EDs) after being resuscitated from opioid overdose. Autopsy studies suggest that multidrug intoxication is a major risk factor for adverse outcomes after acute heroin overdose in patients. If this is true, there may be high-risk drug combinations that identify patients who require more intensive monitoring and prolonged observation. Our objective was to determine the impact of co-intoxication with alcohol, cocaine, or CNS depressant drugs on short-term adverse event rates in patients resuscitated from acute opioid overdose. METHODS: Data were extracted from the database of a prospective opioid overdose cohort study conducted between May 1997 and 1999. Patients were prospectively enrolled if they received naloxone for presumed opioid overdose. Investigators gathered clinical, demographic, and other predictor variables, including co-intoxicants used. Patients were followed to identify prespecified adverse outcome events occurring within 24 h, and multiple logistic regression was used to determine the association of concomitant drug use on short-term adverse event rates. RESULTS: Of 1155 patients studied, 58 (5%) had pure opioid overdose and 922 (80%) reported co-intoxicants, including alcohol, cocaine, and CNS depressants. Overall, out of 1056 patients with known outcome status there were 123 major adverse events (11.6%) and 194 minor adverse events (18.4%). After adjustment for age, gender, HIV status, cardiovascular disease, pulmonary disease and diabetes, we found that coadministration of alcohol, cocaine, or CNS depressants, alone or in combination, was not associated with increased risk of death or adverse events during the 24 h follow-up period. CONCLUSION: In patients resuscitated from acute opioid overdose, short-term outcomes are similar for patients with pure opioid overdose and multidrug intoxications. A history of cointoxication cannot be used to identify high-risk patients who require more intensive ED monitoring or prolonged observation.
PMID: 14705840 [PubMed - indexed for MEDLINE]
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Scorpion envenomations in young children in central Arizona.
LoVecchio F, McBride C.
Department of Emergency Medicine, Good Samaritan Regional Medical and Poison Center, Maricopa Medical Center & Arizona Heart Hospital and Phoenix Children's Hospital, Phoenix, Arizona 85006, USA. frank.lovecchio@bannerhealth.com
INTRODUCTION: Centruroides sculpturatus, also known as Centruroides exilicauda or bark scorpion, is the only scorpion native to the United States whose venom produces a potentially life-threatening illness, particularly in children. OBJECTIVES: To describe the distribution of the severity grades following scorpion envenomations, the onset of clinical signs and symptoms, the time to deterioration, and side effects of antivenom treatment in children < or = 2 yrs of age. METHODS: Prospective case-series with the following inclusion criteria of presumed scorpion envenomation, witnessed scorpion or signs and symptoms consistent with envenomation, patient age < or = 2 yrs, and the call was received by the poison center. After data were entered prospectively, a reviewer who was blinded as to the purpose of the study reviewed the charts. A second reviewer examined 10% of the charts for accuracy in coding. Envenomation severity grades were based on a previously described scorpion grading scale and were correlated with admission rates, clinical deterioration, and outcomes. Descriptive statistics (STATA & EXCEL) were used. RESULTS: Of the 491 charts, 483 (98%) had adequate information available. The mean age was 20.8 [range 2-24] months with 133 patients (27.5%) presenting to an emergency department (ED), 86 patients (17.8%) received antivenom, and 25 patients (5.2%) were admitted. The p-value for kappa and the 95% confidence interval (CI) for interobserver reliability kappa score was 0.69 with CI (0.44-0.95). The grade distributions were Grade I = 343 cases (71%), Grade II = 8 cases (1.7%), Grade III = 49 cases (10.1%), and Grade IV = 83 cases (17.2%). The mean time to advancement of grade was 14 min (95% CI [10.97,17.06], 99% CI [10.04,18.03]) and the median time was < 1 min (range 0-140 min). Twenty-five patients (5.2%) were admitted, of which 13 were Grade III and 12 were Grade IV. Three patients (0.6% of total), all Grade IV envenomations, were intubated (95% CI [0.0021-0.0181] or an upper limit of 8.7 patients). Antivenom was administered to 86 patients (17.8%). The mean time of abatement of symptoms following antivenom was 31 [95% CI 10-82] min vs. 22.2 h [95% CI 12-46]. There was one acute reaction (rash) to antivenom administration and 49 cases (57%) of serum sickness. CONCLUSIONS: Clinical progression following scorpion envenomation in children < or = 2 yrs old occurred on average within 14 min of envenomation with onset almost immediately. Serum sickness occurred in 57% of toddlers receiving antivenom and typically lasted less than 3 days. Admissions were less common among patients receiving antivenom.
PMID: 14705838 [PubMed - indexed for MEDLINE]
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Emergence of imported ciguatera in Europe: report of 18 cases at the Poison Control Centre of Marseille.
de Haro L, Pommier P, Valli M.
Centre Antipoison Hopital Salvator, Marseille, France. deharo.l@jean-roche.univ-mrs.fr
BACKGROUND: Ciguatera is a disease caused by the ingestion of fish containing the toxins of Gambierdiscus toxicus. This dinoflagellate is frequently found in damaged coral reef systems. Previously rare in Europe, this disease entity is now seen in tourists returning from tropical countries. CASE SERIES: Eighteen patients were examined between 1997 and 2002. Nine poisonings occurred in Atlantic Ocean islands, eight in Pacific Ocean islands, and one in the Egyptian Red Sea coast. Gastrointestinal signs were always present in the Atlantic areas, but were less severe or absent in the Pacific areas. All patients had sensory disturbances, and two of them had motor disturbances affecting the respiratory muscles and leading to the death of a 73-year-old man in Cuba. The 17 surviving patients returned to France and for 2 to 18 months suffered from arthralgias, myalgias, or pruritis. CONCLUSION: Ciguatera is a newly imported intoxication in Europe. As the number of international tourists grows each year, this type of poisoning will be seen more frequently. Furthermore, as the condition of coral reefs declines around the world and the prevalence of G. toxicus increases, physicians in non-tropical countries should be prepared to manage such poisoned patients.
Publication Types:
PMID: 14705836 [PubMed - indexed for MEDLINE]
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Suspected pediatric ingestions: effectiveness of immunoassay screens vs. gas chromatography/mass spectroscopy in the detection of drugs and chemicals.
Kyle PB, Spencer JL, Purser CM, Eddleman KC, Hume AS.
Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA. pkyle@pharmacology.umsmed.edu
Rapid and accurate analytical testing can be of great value when determining treatment for pediatric patients suspected of ingesting an unknown chemical. Though often overlooked, gas chromatography/mass spectroscopy (GC/MS) can be a valuable resource in emergency toxicology testing. In a recent 24-month period (July 1999-June 2001), the Analytical Toxicology Laboratory at the University of Mississippi Medical Center, Jackson, MS, compared the results of GC/MS analysis to results obtained by immunoassay testing. The laboratory tested 139 urine samples referred for STAT toxicology testing from the hospital's Pediatric Emergency Department. All samples were tested in parallel using an immunoassay technique (EMIT) and GC/MS. With analysis by immunoassay, 17.3% of the samples were positive for a drug of abuse. The number of positive drug classes ranged from 0 to 2 per sample (mean 0.17 +/- 0.43) using immunoassay. With analysis by GC/MS, drugs were detected in 88.5% of the samples. The number of drugs detected ranged from 0 to 11 per sample (mean 2.2 +/- 1.8) with GC/MS. A total of 64 different pharmaceuticals were identified by GC/MS. This study shows that analysis by GC/MS offers the clinician a more comprehensive view into the exposure of the pediatric patient presenting with an unknown chemical ingestion.
PMID: 14705835 [PubMed - indexed for MEDLINE]
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Guideline for the out-of-hospital management of human exposures to minimally toxic substances.
McGuigan MA; Guideline Consensus Panel.
American Association of Poison Control Centers in collaboration with the American Academy of Clinical Toxicology and the American College of Medical Toxicology, Washington, DC 20016, USA. aapcc@poison.org
All substances are capable of producing toxicity, so nothing is completely non-toxic. Minimally toxic substances are those which produce little toxicity, minor self-limited toxicity, or clinically insignificant effects at most doses. Examples include silica gel, A&D ointment, chalk, lipstick, and non-camphor lip balms, watercolors, hand dishwashing detergents, non-salicylate antacids (excluding magnesium or sodium bicarbonate containing products), calamine lotion, clay, crayons, diaper rash creams and ointments, fabric softeners/sheets, glow products, glue (white, arts, and crafts type), household plant food, oral contraceptives, pen ink, pencils, starch/sizing, throat lozenges without local anesthetics, topical antibiotics, topical antifungals, topical steroids, topical steroids with antibiotics, and water-based paints. Minimally toxic exposures have the following characteristics: (1) The information specialist has confidence in the accuracy of the history obtained and the ability to communicate effectively with the caller. (2) The information specialist has confidence in the identity of the product(s) or substance(s) and a reasonable estimation of the maximum amount involved in the exposure. (3) The risks of adverse reactions or expected effects are acceptable to both the information specialist and the caller based on available medical literature and clinical experience. (4) The exposure does not require a healthcare referral since the potential effects are benign and self-limited. However, decisions regarding patient disposition should take into account the patient's intent, symptoms, and social environment. In addition, individual patient circumstances (e.g., pregnancy, pre-existing medical conditions, therapeutic interventions) need to be considered. Minimally toxic exposures may vary in route (dermal, inhalation, ingestion, ocular), chronicity (acute, chronic), and substance composition (single or multi-ingredient, single or multiple product). Future categorization of substances as "minimally toxic" should be based on a process involving review of current knowledge, a thorough analysis of poisoning experience, and prospective validation.
Publication Types:
- Guideline
- Practice Guideline
PMID: 14705834 [PubMed - indexed for MEDLINE]
Comment in:
Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C virus coinfection.
Qurishi N, Kreuzberg C, Luchters G, Effenberger W, Kupfer B, Sauerbruch T, Rockstroh JK, Spengler U.
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
BACKGROUND: Highly active antiretroviral therapy (HAART) has improved the prognosis of HIV infection. However, replication of hepatitis C virus (HCV) is not inhibited by HAART, and treatment-related hepatotoxicity is common. To clarify the effect of HAART in HIV/HCV-coinfected patients, we studied liver-related mortality and overall mortality in 285 patients who were regularly treated during the period 1990-2002 at our department. METHODS: Survival was analysed retrospectively by Kaplan-Meier and Cox's regression analyses after patients (81% haemophiliacs) had been stratified into three groups according to their antiretroviral therapy (HAART n=93, available after 1995; treatment exclusively with nucleoside analogues n=55, available after 1992; or no treatment, n=137). FINDINGS: Liver-related mortality rates were 0.45, 0.69, and 1.70 per 100 person-years in the HAART, antiretroviral-treatment, and untreated groups. Kaplan-Meier analysis of liver-related mortality confirmed the significant survival benefit in patients with antiretroviral therapy (p=0.018), and regression analysis identified HAART (odds ratio 0.106 [95% CI 0.020-0.564]), antiretroviral treatment (0.283 [0.103-0.780]), CD4-positive T-cell count (0.746 [0.641-0.868] per 0.05x10(9) cells/L), serum cholinesterase (0.962 [0.938-0.986] per 100 U/L), and age (1.065 [1.027-1.105] per year) as independent predictors of liver-related survival. Severe drug-related hepatotoxicity was seen in five patients treated with nucleoside analogues alone and 13 treated with HAART. No patient died from drug-related hepatotoxicity. INTERPRETATION: In addition to improved overall survival, antiretroviral therapy significantly reduced long-term liver-related mortality in our patients. This survival benefit seems to outweigh by far the associated risks of severe hepatotoxicity.
PMID: 14643119 [PubMed - indexed for MEDLINE]
Comment on:
A tale of two viruses: hepatitis C in the age of HAART.
Alatrakchi N, Koziel MJ.
Infectious Disease Division, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Publication Types:
PMID: 14643113 [PubMed - indexed for MEDLINE]
Comment on:
Preventing foodborne disease--what clinicians can do.
Acheson DW, Fiore AE.
Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, Md, USA.
Publication Types:
PMID: 14749450 [PubMed - indexed for MEDLINE]
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