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By Aaron Guinn Canadian emergency medicine physician - clinical diagnosis, sepsis and tox
Adrienne Hughes, Alisha Brown, Matthew Valento
Baking soda is a readily available household product composed of sodium bicarbonate. It can be used as a home remedy to treat dyspepsia. If used in excessive amounts, baking soda has the potential to cause a variety of serious metabolic abnormalities. We believe this is the first reported case of hemorrhagic encephalopathy induced by baking soda ingestion. Healthcare providers should be aware of the dangers of baking soda misuse and the associated adverse effects.
September 2016: Western Journal of Emergency Medicine
James M Feeney, Elizabeth Santone, Monica DiFiori, Lilla Kis, Vijay Jayaraman, Stephanie C Montgomery
BACKGROUND: Falls represent the leading cause of traumatic brain injury in adults older than 65, with nearly one third experiencing a fall each year. Evidence suggests that up to 0.5% of anticoagulated patients suffer from intracranial hemorrhage (ICH) annually. Direct oral anticoagulants (DOACs) have become an increasingly popular alternative to warfarin for anticoagulation; however, there is a dearth of research regarding the safety of DOACs, in particular on the outcome of traumatic ICH while taking DOACs...
November 2016: Journal of Trauma and Acute Care Surgery
Sophie Gosselin, Lotte C G Hoegberg, Robert S Hoffman, Andis Graudins, Christine M Stork, Simon H L Thomas, Samuel J Stellpflug, Bryan D Hayes, Michael Levine, Martin Morris, Andrea Nesbitt-Miller, Alexis F Turgeon, Benoit Bailey, Diane P Calello, Ryan Chuang, Theodore C Bania, Bruno Mégarbane, Ashish Bhalla, Valéry Lavergne
BACKGROUND: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning. METHODS: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences...
September 8, 2016: Clinical Toxicology
Gillian A Beauchamp, Robert G Hendrickson, Benjamin W Hatten
BACKGROUND: Endotracheal intubation remains a cornerstone of early resuscitation of the poisoned patient, but little is known about which substances are associated with intubation. OBJECTIVES: Our objective was to describe patient exposures to substances reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) that were managed with intubation between 2010 and 2014. METHODS: We performed a retrospective review of cases managed with endotracheal intubation in the ACMT ToxIC Registry from January 1, 2010 through December 31, 2014...
October 2016: Journal of Emergency Medicine
Matthew D Hensley, Vikhyat S Bebarta, Douglas J Borys
OBJECTIVE: Significant adverse effects after acute pediatric methotrexate (MTX) exposures have been limited to parenteral exposures. Treatment recommendations for pediatric MTX exposures do not differentiate between routes of exposure. We report the incidence of significant clinical effects and drug-specific treatments reported in a large series of acute, pediatric MTX ingestions. METHODS: Poison center records of all MTX ingestions by patients younger than 17 years during 2000 to 2005 were collected from 6 poison centers...
July 2, 2016: Pediatric Emergency Care
Timothy Clive Marrs, John Paul Thompson
INTRODUCTION: Dicobalt edetate is one of a number of cobalt compounds that have been studied in the treatment of cyanide poisoning, their efficacy being based upon the fact that cyanide combines with cobalt to form relatively non-toxic complexes. Inorganic cobalt salts are quite toxic (cyanide and cobalt antagonise one another's toxicity) and complexes such as dicobalt edetate were studied with the aim of identifying compounds that were less acutely toxic, but which retained the antidotal properties of cobalt salts...
September 2016: Clinical Toxicology
Brandon J Warrick, Anita Paula Tataru, Susan Smolinske
CONTEXT: Pharmacologically induced shock can be refractory to standard resuscitation. Methylene blue (MB) acts to prevent nitric oxide-mediated vasodilation and may be a potential treatment for refractory shock. OBJECTIVE: A systematic analysis of the literature to evaluate MB in pharmacologically induced shock. Primary outcome was survival and secondary outcome was hemodynamic improvement. MATERIALS AND METHODS: A search of MedLine/PubMed, EMBASE, Cochrane Library, TOXLINE, Google Scholar and Google was performed 10 August 2015 using a combination of text words and keywords related to MB, shock and specific drugs...
August 2016: Clinical Toxicology
Joseph D Roderique, Christopher S Josef, Alden H Newcomb, Penny S Reynolds, Leonardo G Somera, Bruce D Spiess
BACKGROUND: Current management of acute inhalational carbon monoxide (CO) toxicity includes hyperbaric or normobaric O2 therapy. However, efficacy has not been established. The purpose of this study was to establish therapeutic proof of concept for a novel injectable antidote consisting of the combination of hydroxocobalamin and ascorbic acid into a reduced form (B12r) as demonstrated by clinically significant increase (>500 ppm) in CO2 production, reduced carboxyhemoglobin (COHgb) half-life (COHgb t1/2), and increased cerebral O2 delivery and attenuation of CO-induced microglial damage in a preclinical rodent model of CO toxicity...
October 2015: Journal of Trauma and Acute Care Surgery
Joshua C Reynolds, Bryan S Judge
Flecainide is a class Ic antidysrhythmic agent used to prevent and treat tachydysrhythmias. Flecainide toxicity primarily causes cardiovascular and neurologic effects through sodium-channel blockade. There is scant evidence to support specific management, and recommended therapies have been extrapolated from management of other sodium-channel blocking drugs. Traditionally, these therapies have consisted of intravenous fluids, sodium bicarbonate, vasopressors, and cardiac pacing. Novel therapies include intravenous fat emulsion and venoarterial extracorporeal membrane oxygenation (VA-ECMO)...
October 2015: American Journal of Emergency Medicine
Ingrid Berling, Geoffrey K Isbister
OBJECTIVES: Measuring the QT interval on an electrocardiogram (ECG) is integral to risk assessment of Torsade de Pointes (TdP). This study aimed to investigate the accuracy of the 1/2 RR rule as a risk assessment tool for drug-induced TdP, comparing it to the QT nomogram, Bazett's corrected QT (QTcB), and Fridericia's corrected QT (QTcF). METHODS: The authors calculated sensitivity and specificity of the 1/2 RR rule using a published data set of 129 cases of drug-induced TdP and 316 controls (noncardiotoxic overdoses), compared to the QT nomogram, QTcB > 500 msec and QTcF > 500 msec...
October 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michael Levine, Margaret Huang, Sean O Henderson, Guy Carmelli, Stephen H Thomas
In recent years, dabigatran has emerged as a popular alternative to warfarin for treatment of atrial fibrillation. If rapid reversal is required, however, no reversal agent has clearly been established. The primary purpose of this manuscript was to evaluate the efficacy of tranexamic acid and aminocaproic acid as agents to reverse dabigatran-induced coagulopathy. Rats were randomly assigned to 6 groups. Each rat received either dabigatran or oral placebo, followed by saline, tranexamic acid, or aminocaproic acid...
June 3, 2015: American Journal of Therapeutics
Simon T B Chan, C K Chan, M L Tse
OBJECTIVES: To evaluate the failure rate of the 150-treatment line for paracetamol overdose in Hong Kong, and the impact if the treatment threshold was lowered. SETTING: Public hospitals, Hong Kong. PATIENTS: All patients with acute paracetamol overdose reported to the Hong Kong Poison Information Centre from 1 January 2011 to 31 December 2013 were studied and analysed for the timed serum paracetamol concentration and their relationship to different treatment lines...
October 2015: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Carlos Rodrigo Camara-Lemarroy, René Rodríguez-Gutiérrez, Roberto Monreal-Robles, José Gerardo González-González
BACKGROUND: Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication...
2015: BMC Emergency Medicine
Simon H L Thomas, Elijah R Behr
Torsades de pointes (TdP) is a characteristic polymorphic ventricular arrhythmia associated with delayed ventricular repolarization as evidenced on the surface electrocardiogram by QT interval prolongation. It typically occurs in self-limiting bursts, causing dizziness and syncope, but may occasionally progress to ventricular fibrillation and sudden death. Acquired long QT syndromes are mainly caused by cardiac disease, electrolyte abnormalities or exposure to drugs that block rectifying potassium channels, especially IKr...
March 2016: British Journal of Clinical Pharmacology
Jessica W Wang, Violetta Kivovich, Laurie Gordon
OBJECTIVES: Ketamine is a recreational drug widely abused in East Asia and also in certain subpopulations of the United States. Many US clinicians are unaware of abuse symptoms, leading to misdiagnosis and missed opportunities for intervention. We will discuss clinical patterns that should alert a clinician to the possibility of ketamine abuse. METHODS: We present 6 adolescent patients who presented to the pediatric emergency department and inpatient wards with urinary and hepatobiliary symptoms in the setting of ketamine abuse...
August 5, 2015: Pediatric Emergency Care
Kenji Kamiya, Kotaro Ozasa, Suminori Akiba, Ohstura Niwa, Kazunori Kodama, Noboru Takamura, Elena K Zaharieva, Yuko Kimura, Richard Wakeford
Late-onset effects of exposure to ionising radiation on the human body have been identified by long-term, large-scale epidemiological studies. The cohort study of Japanese survivors of the atomic bombings of Hiroshima and Nagasaki (the Life Span Study) is thought to be the most reliable source of information about these health effects because of the size of the cohort, the exposure of a general population of both sexes and all ages, and the wide range of individually assessed doses. For this reason, the Life Span Study has become fundamental to risk assessment in the radiation protection system of the International Commission on Radiological Protection and other authorities...
August 1, 2015: Lancet
Arifumi Hasegawa, Koichi Tanigawa, Akira Ohtsuru, Hirooki Yabe, Masaharu Maeda, Jun Shigemura, Tetsuya Ohira, Takako Tominaga, Makoto Akashi, Nobuyuki Hirohashi, Tetsuo Ishikawa, Kenji Kamiya, Kenji Shibuya, Shunichi Yamashita, Rethy K Chhem
437 nuclear power plants are in operation at present around the world to meet increasing energy demands. Unfortunately, five major nuclear accidents have occurred in the past--ie, at Kyshtym (Russia [then USSR], 1957), Windscale Piles (UK, 1957), Three Mile Island (USA, 1979), Chernobyl (Ukraine [then USSR], 1986), and Fukushima (Japan, 2011). The effects of these accidents on individuals and societies are diverse and enduring. Accumulated evidence about radiation health effects on atomic bomb survivors and other radiation-exposed people has formed the basis for national and international regulations about radiation protection...
August 1, 2015: Lancet
Peter Laux, Tewes Tralau, Jutta Tentschert, Annegret Blume, Sascha Al Dahouk, Wolfgang Bäumler, Eric Bernstein, Beatrice Bocca, Alessandro Alimonti, Helen Colebrook, Christa de Cuyper, Lars Dähne, Urs Hauri, Paul C Howard, Paul Janssen, Linda Katz, Bruce Klitzman, Nicolas Kluger, Lars Krutak, Thomas Platzek, Victoria Scott-Lang, Jørgen Serup, Wera Teubner, Ines Schreiver, Elena Wilkniß, Andreas Luch
Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used...
January 23, 2016: Lancet
Darren M Roberts, Nick A Buckley
CONTEXT: Despite a worldwide decline in barbiturate use, cases of acute poisoning with severe toxicity are still noted, particularly in developing countries. Severe poisonings often require prolonged admission to an intensive care unit, so enhanced elimination might be useful to hasten recovery. Information regarding the efficacy of these techniques for individual barbiturates is not available in standard textbooks. OBJECTIVE: To determine the evidence supporting the effect of enhanced elimination and its role in the management of acute barbiturate poisoning...
January 2011: Clinical Toxicology
Jordan Trecki, Roy R Gerona, Michael D Schwartz
Synthetic cannabinoids (SCs) were first created in the 1980s as laboratory research tools (ligands) for studying human endocannabinoid receptor systems. SC-containing products supplied by illicit manufacturers were then marketed throughout Europe as herbal incense, before arriving in the United..
July 9, 2015: New England Journal of Medicine
2015-07-21 15:26:28
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