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Herbal Weight-Loss Supplement Misadventures Per a Regional Poison Center (May).
Robinson RF, Griffith JR, Nahata MC, Mahan JD, Casavant MJ.
Department of Pediatrics, College of Medicine, The Ohio State University; Children's Research Institute, Central Ohio Poison Control Center, Columbus, OH.
BACKGROUND: Many herbal supplements used for weight loss contain stimulants. The poison control center has noted an increase in reports of adverse events with intentional and unintentional ingestion of herbal weight-loss supplements. OBJECTIVE: To identify characteristics of the callers (eg, demographic properties, underlying type of ingestion) and, from this information, determine populations at increased risk for adverse events secondary to intentional and unintentional herbal weight-loss supplement ingestion. METHODS: Demographic information such as patient weight, age, gender, and medical history was recorded from ingestions reported to the Central Ohio Poison Control Center (COPC) in 2000. Ingredients, concurrent medications, ingestion and treatment site, clinical presentation, and therapies received were documented. Type of ingestion, acuity, clinical presentation, and treatment site were used to identify patients at increased risk of adverse events secondary to herbal supplement ingestion. RESULTS: Eighty calls were recorded in 2000 (49 females involved). Underlying reasons for ingestion differed between males and females (p = 0.025). Twenty-five percent of the intentional ingestions and 51% of the unintentional ingestions occurred in males. Reported symptoms differed with the underlying reason for ingestion (p </=0.001) and were more common in intentional ingestions (80%). Symptoms were reported more often with unknown or higher-than-recommended doses (78%); however, 70% (n = 10) of subjects ingesting the recommended dose reported at least one symptom (p = 0.15). CONCLUSIONS: Intentional and unintentional ingestions of herbal supplements for weight loss vary with age and gender. The significant presence of symptoms in nonabusers requires more study to assess overall safety and potential toxicity of agents such as Stacker 2. Patients who abuse or misuse herbal weight-loss supplements are generally women, who may seek medical treatment more often.
PMID: 15044657 [PubMed - as supplied by publisher]
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Dexmedetomidine Overdose in the Perioperative Setting (May).
Jorden VS, Pousman RM, Sanford MM, Thorborg PA, Hutchens MP.
Abbott Laboratories, Inc., Abbott Park, IL; Clinical Assistant Professor, Department of Anesthesiology, The Chicago Medical School, Chicago, IL.
OBJECTIVE: To report 3 cases of accidental dexmedetomidine overdose in the perioperative setting and review the pathophysiology of alpha2-agonist overdose. CASE SUMMARIES: Three patients accidentally received overdoses of dexmedetomidine, one intraoperatively (192 micro g over 20 min) and 2 postoperatively (4 and 2 rather than 0.4 and 0.2 micro g/kg/h; 0.5 micro g/kg/min rather than 0.5 micro g/kg/h). Hemodynamic parameters remained stable for all 3 patients. The most notable sign was oversedation diagnosed either clinically or using a bispectral index monitor; Naranjo criteria suggest possible or probable association of the reactions with dexmedetomidine. In all 3 cases, oversedation resolved within one hour of drug discontinuation. There were no other sequelae, and the remainder of each patient's hospital course was unremarkable. DISCUSSION: As of this writing, dexmedetomidine dosing in excess of the label recommendation has been reported, but accidental dexmedetomidine overdose in clinical practice has not been described. Excessive levels of sedation were the only significant finding in all 3 patients. Dexmedetomidine's short redistribution half-life of 6 minutes should lead to rapid resolution of oversedation induced by overdoses if the overall duration of infusion is short (</=8 h). While the patients reported here were hemodynamically stable, dexmedetomidine may engender significant hemodynamic changes either because of sympatholysis at normal doses or vasoconstriction at higher than recommended doses. The absence of a significant hypertensive response to high dexmedetomidine concentrations suggests that dexmedetomidine-induced hypertension may be multifactorial, not simply related to plasma drug concentrations. CONCLUSIONS: Practitioners presented with dexmedetomidine overdose should be prepared to manage oversedation. While hemodynamic alterations may be seen with dexmedetomidine use, hypertension from high dexmedetomidine plasma concentrations is not a consistent response. Practitioners using dexmedetomidine should carefully note that dosing for this agent is described by the manufacturer in micro g/kg/h, not micro g/kg/min.
PMID: 15039474 [PubMed - as supplied by publisher]
Severe cholestatic hepatitis induced by pyritinol.
Maria V, Albuquerque A, Loureiro A, Sousa A, Victorino R.
Institute of Molecula Medicine, Clinical Immunology Unit and Department of Medicine 2, Faculty of Medicine of Lisbon, Hospital of Santa Maria, Av Prof Egas Moniz, 1649-028 Lisbon, Portugal. vascomaria@fm.ul.pt
Publication Types:
PMID: 15001508 [PubMed - indexed for MEDLINE]
Determination of phenol and o-cresol by GC/MS in a fatal poisoning case.
Boatto G, Nieddu M, Carta A, Pau A, Lorenzoni S, Manconi P, Serra D.
Dipartimento Farmaco Chimico Tossicologico, Universita degli Studi di Sassari, Sassari, Italy. gboatto@uniss.it
A fatality due to the ingestion of solution containing phenol and o-cresol is described. The pathological findings were typical of acute substantial poisoning. Blood, urine and stomach content were obtained during post mortem examinations. Phenol and o-cresol were identified using GC/MS. The extractions from autopsy materials were obtained as follows: by gel permeation with cyclohexane/dichloromethane from stomach content, by solid phase extraction (SPE) from urine and by deproteinization with acetonitrile from blood. The phenol and o-cresol concentrations in the samples were found, respectively, as follows: 115.0 and 5.0 microg/g in the stomach contents, 58.3 and 1.9 microg/ml in the blood, 3.3 and 20.5 microg/ml in the urine. Distributions of phenol in fatal poisonings have been reported, but, usually, colorimetry was used as the analytical method and it cannot exclude the interference of other phenolic compounds.
PMID: 15040915 [PubMed - in process]
Unintentional and undetermined poisoning deaths--11 states, 1990-2001.
Centers for Disease Control and Prevention (CDC).
During 1990-2001, the death rate from poisoning in the United States increased 56%, from 5.0 per 100,000 population in 1990 to 7.8 in 2001. In 2001, of 22,242 poisoning deaths, 14,078 (63%) were unintentional. To describe trends in poisoning deaths, state health professionals in 11 states analyzed vital statistics data for 1990-2001. This report summarizes the results of that analysis, which indicated that increases in state death rates from unintentional and undetermined poisonings varied, but increased by an average of 145%; a total of 89% of poisonings involved drugs and other biologic substances. State public health professionals can use local, state, and national surveillance data to monitor trends in drug misuse and to develop effective interventions that can reduce deaths from drug overdoses.
PMID: 15041950 [PubMed - in process]
Licensing thalidomide in Australia.
Crawford CL.
Publication Types:
PMID: 14960148 [PubMed - indexed for MEDLINE]
Viral encephalitis complicated by neuroleptic malignant syndrome in a 7-year-old girl.
Hillis RE, Lee DA.
Department of Psychiatry and Neurology, Tulane University Health Science Center, New Orleans, Louisiana, USA.
Publication Types:
PMID: 12698035 [PubMed - indexed for MEDLINE]
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Severe dyspnea due to jellyfish envenomation.
Armoni M, Ohali M, Hay E.
Pediatric Emergency Department, Barzilai Medical Center, Ashkelon 78306, Israel.
During the summer, jellyfish stings are the most common envenomation situations encountered by humans in the marine environment. The more people swim, scuba dive, or snorkel, the more necessary it is to know what should be done immediately, how life can be saved, how to prevent early and late complications, and how to facilitate convalescence in the event of jellyfish envenomation. We describe an atypical case of a 14-year-old boy with severe dyspnea due to upper airway obstruction caused by a jellyfish sting to the face and outline a practical approach to the treatment of jellyfish stings.
Publication Types:
PMID: 12698031 [PubMed - indexed for MEDLINE]
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